Slaff, a 73-year-old retiree, was covered under Medicare for medical expenses. When Slaff experienced difficulty breathing,...

Slaff, a 73-year-old retiree, was covered under Medicare for medical expenses. When Slaff experienced difficulty breathing, she visited her family doctor for assistance. Her family doctor referred her to a pulmonologist, a specialist in respiratory illnesses, who prescribed a drug to address the medical condition. Can Slaff receive benefits under Medicare Part A to cover the fee charged by her general practitioner? Can Slaff receive benefits under Medicare Part B to cover the fee charged by her pulmonologist? Is Slaff’s pharmacist required to adhere to the privacy provisions included in HIPAA?

Expert Solution

Medicare Plan A is a plan suitable for inpatient care and services i.e. when the patient is hospitalized and receiving treatments as a part of inpatient care. So, Slaff cannot receive benefits under Medicare A to cover the fee charged by her general practitioner.

Medicare Plan B refers to a plan that covers all outpatient care and services and also doctor care. If Slaff is covered under this plan, she can receive benefits to cover the fee charged by her pulmonologist. If she is under this plan, she can also receive benefits to cover the fee charged by her family doctor (general practitioner).

As per the Health Insurance Portability and Accountability Act (HIPAA), clinics, doctors, nursing homes, pharmacies, etc are required to abide by this act, especially for medicare plans. So, Slaff's pharmacist provider has to adhere to the privacy provisions included in HIPAA which is to set standards as to when and how health-related information (including doctors that the patient is being referred to, medicines that the patient is prescribed) regarding an individual may be used or disclosed.

keosha answered 2 years ago

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