OCC 545 WELLNESS REIMBURSEMENT (Leadership Class) WORKSHEET WEST COAST UNIVERSITY
Reimbursement Worksheet
Briefly describe the items below asthey relate to reimbursement/funding for occupational
therapy services:
Item Description
Medicare Part A Coversinpatient hospitalstays,skilled nursing facility care, hospice
care, lab tests, surgery, and some home health care. To qualify for
Medicare Part A is individuals that are 65 years and older.
Medicare Part B Covers outpatient care, private practice, hospital outpatient clinic,
home health care, medical supplies, durable medical equipment,
and some preventive services. Patients have a choice to take Part B
coverage but it isn't necessary. However, you must be enrolled in
Parts A and B to join a Medicare Advantage plan. Usually there is a
limit to use this funding.
Medicaid Covers federal-state assistance programs and low-income
individuals In California coming from federal and state funding
(public programs). It is called Medi-CAL and for children, it is called
California Children’s Services(CCS). Usually the reimbursement rate
is lowest but has strict regulations.
PPO/HMO PPO and HMO are private insurance. HMO stands for health
maintenance organization, which is private and has a much cheaper
cost. Additionally, it has higher deductibles and has a higher client
expectation/reduced use of services. The patient will choose from a
list of providers but all speciality services must be approved and
have an existing referral from an M.D.
PPO stands for Preferred Provider Organization, which is a type of
managed-care health insurance plan that provides coverage through
a network of contracted healthcare providers. The patient is able to
pick specialists that are out of network and is more flexible. It costs
more money for the patient but they are given an unlimited list of
providers. The downside to this option is that they have higher
out-of-pocket costs.