Audit 's Audit Results And Outline A Recoupment Process For Hospitals With The New Hampshire Hospital

The Hospital Corporation of America (HCA) is the United States leading provider of healthcare services. Headquartered in Nashville, Tennessee, HCA operates multiple inpatient and outpatient services via locally managed subsidiary facilities in twenty states throughout the U.S. and the United Kingdom. As the preeminent hospital organization in the country, HCA employs approximately 225,00 healthcare professionals and has local market affiliations with approximately 37,000 active physicians.

This paper will describe current quality outcome measures and the significance for improving medical care. Organizational accountability and transparency has improved with the emergence of Hospital Inpatient Quality Reporting (IQR) programs and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPs). This article will review the role of the nurse manager in creating a culture for quality care as well as the nurse for meeting organizational and patient expectations. Organizations like The Joint Commission (JC), Agency for Healthcare Research and Quality (AHRQ), Centers for Medicare and Medicaid Services (CMS), and The American Nurses Association (ANA) have been critical in establishing standards for quality. This paper will also report on the most recent hospital statistics and steps taken to improve HCAHP scores and reduce readmission rates at the University of Tennessee Medical Center in Knoxville (UTMCK). Statistics at UTMCK will also be compared to the Tennessee and National averages found on the Medicare website Hospital Compare. The aim of this paper is to explore if healthcare system initiatives are improving quality and enhancing patient outcomes.

The current paper examines the Disproportionate Share Hospital Payment Reduction CMS 2367F rule which was effective on November 18, 2013. The Disproportionate Share Hospital Payment Reduction CMS 2367F is Federal Legislation that was implemented due to the Affordable Care Act. The rule was initially proposed by the Centers for Medicare & Medicaid Services (CMS), HHS on May 13, 2013. The proposed rule was to implement the provision of the Affordable Care Act that reduces Medicaid Disproportionate Share Hospital (DSH) allotments.

These proposals often focus on using hospital DSH payments to expand coverage rather than using these sums to make payments to hospitals, using savings from reductions in other programs, or proposing new revenues (Holahan et al., 1995). The goal is to expand coverage at small new costs to the government (Holahan et al., 1995). The key features of

See Electcrostim Med. Servs., Inc. v. Health Care Serv. Corp., 962 F. Supp. 2d 887, 898-99 (S.D. Tex. 2013) (granting motion to dismiss); Encompass Office Solutions, Inc. v. Conn. Gen. Life Ins. Co., No. 3:11-cv-02487-L, 2012 WL 3030376, *8-*9 (N.D. Tex. July 25, 2012) (denying motion to dismiss); Team Healthcare/Diagnostic Corp. v. Blue Cross & Blue Shield of Tex., No. 3:10-cv-1441-BH, 2012 WL 1617087, *6 (N.D. Tex. May 7, 2012) (denying motion to dismiss); Mid-Town Surgical Ctr., LLP v. Blue Cross Blue Shield of Tex., No. H-11-2086 (S.D. Tex. Apr. 11, 2012) (granting motion to dismiss); DAC Surgical Partners, P.A. v. United Healthcare Servs., Inc., No. H-11-1355, 2011 WL 3841946, *6 (S.D. Tex. Aug. 30, 2011) (denying motion to dismiss);

The Hospital Fairness and Transparency Act, state of Massachusetts, I feel it is important for communities’ to be aware, and to ensure their taxpayer dollars are instead dedicated to safe patient care and necessary services in the Commonwealth, and in other states as well. I find it admirable that Advocates actually provided legislators with a list of hospitals with funds stored in offshore accounts and will urge legislators to demand greater transparency by passing the HPTFA. Today communities are asking more questions related to healthcare facilities finances in their communities. Massachusetts health care costs

Both rulings bring about interesting points involving how healthcare is paid for, purchased, and how it is determining who is eligible for it. Health care alone is a unique market that combines many variables with few realistic purchasing alternatives and affordable options for care treatments. Those treatments are very expensive and traditionally difficult to pay out of pocket for Most people except for their yearly check-ups and immunizations do not plan for the random costs and unintentional illnesses and injury that are exclusive to the healthcare market. The costs associated with ER visits, which tend to be relatively expensive, and the healthcare provided to those whether they are uninsured or insured incurs a significant cost that is

The HAC Reduction program requires the Secretary of the Department of Health and Human Services to adjust payments to those hospitals that rank worse than others

The CMS reimbursement rules for never events cause serious revenue loss for the hospitals, hence a shift in the patient care delivery model in inpatient facilities is required. The goal of this rule is to motivate hospitals to accelerate improvement

The justification for this subsidy has changed over time. Originally, the DSH adjustment was intended to compensate hospitals for their higher Medicare costs associated with the provision of services to a large proportion of low-income patients. Now, the adjustment is considered as a way to protect access to care for Medicare beneficiaries. The Affordable Care Act as amended by the Reconciliation Act will reduce hospitals’ DSH payments starting in FY2014 equal to 25% of what otherwise be made. Acute care hospitals will be paid additional amounts, which will depend on the difference in the hospital’s DSH payments under this Act, the difference in the percentage change in the uninsured under-65 population from 2012, and the percentage of uncompensated care provided by the hospital relative to all acute care hospitals. It has beens estimated that this policy will save $22.1 billion from FY2015 to

Four years ago, Massachusetts’ Medicaid program (called MassHealth) faced a crisis. The eEligibility rules of the Affordable Care Act required the state to change eligibility systems and the initial effort to build “the Cadillac” of eligibility systems ended in a costly spectacular failure, and an FBI investigation as a result of a Pioneer Institute report drawn from inside whistleblower accounts.

If the Centers for Medicare & Medicaid Services (CMS) change their payer regulations and accreditation requirements, hospitals would need to accommodate their requests for continued supplemental payments. In other words,

Though they are not entirely comprehensive tools, a great deal can be learned about a hospital or other healthcare organization for-profit or not-for-profit from an examination of their annual financial documents (Finkler & Ward, 2006). The balance sheet and statement of revenue and expense can both yield valuable clues even in the absence of other evidence about changes that might be occurring in the organization, a definition of the type and degree of certain problems that it might be facing, and potential opportunities for improvement in performance that might exist (Finkler & Ward, 2006). Comparing two or more years' worth of financial information yields even more valuable insights, tracking movement in the hospital or other organization's ability to finance its activities and thus continue providing services at the same level, quantity, and scope as current operation.

The Massachusetts General Hospital is a healthcare hospital located in the West End neighborhood of Boston, Massachusetts and is proclaimed to be one of the leading healthcare providers in the nation, with it having the prestige of being the original and largest teaching hospital of Harvard Medical School and a biomedical research facility and the largest healthcare provider in Massachusetts. When first observing the website, one of the main things that is stated on the first page and is clearly stated in big bold letters is the proclamation of the achievement that the hospital holds. It is stated that the Massachusetts General Hospital has been named among the top hospitals in America and it has been ranked among the top three of hospitals

The unhealthy hospital case is about a hospital named Blake Memorial that has been in a very bad shape, lacks in providing the best quality of care, is in debt, and financially imbalanced. It is important for a healthcare set up to maintain balance in the financial system so the stakeholders and customers who are the patients their interests are met. If the hospital is lacking in providing the best quality of care for its community and the community is in high needs of the care than the CEO’s of the hospitals need to make a change. The patients (customers) look for getting the best services and better results from a hospital and the stakeholder’s looks for better profitable gain from their business by running the hospitals. In this case