Solutions for Government

The Government, as the major buyer of services, must take a hard look at how Medicare and Medicaid are managed, or mismanaged. Unfortunately over time, the application of both programs has eroded to the destination of looking only at the monetary aspect rather than the service component.

The Intermediaries have imposed their misinterpreted rules and limits as to what they will pay for, and most are contrary to the actual regulations. Medicare Insurance has been purchased by the patients with the entitlement of being rehabilitated to their highest level of functioning within a 100-day period. Medicaid is a government-funded program for the indigent, is the payer of last resort, and is usually erroneously billed for expense that should have been paid by Medicare. Unfortunately, the misapplication of both programs is resulting in a hardship for both patient and provider.

Government must enact changes to ensure these programs are administered as they were originally intended. When patients are allowed to receive their entitled benefits, they function at a higher level and many return home. For Medicaid to be financially viable they cannot continue to pay bills that Medicare should be paying.

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