Healthcare Contract Analysis

The five most important characteristics for a healthcare provider is honesty, patience, empathy, responsibility, and a team player. I picked honesty because for me honesty is important because if I was the patient I would like for the nurses and doctors be completely honest with me. To be honest you have trustful. Patients should be able to always have faith in you. You always have to be honest with the patients no matter what. Honesty has a lot to do with the healthcare industry.

Regional Hospital is located in charlotte Mecklenburg North Carolina and serves a community of an estimated 875,000 members within the integrated delivery system (IDS). Recent efforts are being spent on reviewing several proposals for integration of a disease management contract that will assist in reducing utilization costs with the primary goal of improving our patient health outcomes.

Our Healthcare system is clearly business based according to the article “Cost Conundrum” and on the movie “Escape Fire”. In the movie it had an impacting story of an older lady who had heart problems where she went to a doctor and they were going to charge her thousands of dollars were later she went to a different doctor and they charged her a couple hundred dollars for t he same procedure. I couldn’t believe that in a different office she would get the same procedure done for a lot cheaper than in the other doctor’s office. Also, it surprised me how the medical staff are giving all these medications to our soldiers were they are clearly

The Affordable Care Act (ACA) was signed on March 23, 2010 by President Barack Obama. The enactment of the ACA accounted for medical reform throughout the United States (Osmonbekov, Yordy, & Gregory, 2014). The provisions of document were all geared towards enhancing healthcare by lowering the costs, creating new consumer protections as well as improving access to care. Some of the provisions include section 2706 which establishes nondiscrimination in healthcare. Further, section 4001 provides national prevention, public health council, health promotion as well as an advisory group on prevention and integrative medical issues. The above provisions affect acupuncture practitioners in various ways.

Social capital includes two avenues – bridging and bonding, that have the the ability to improve healthier outcomes in communities; research has shown that communities with higher levels of social capital have a higher mortality rate (Policy Link, 2002). Bonding improves the overall relationships, as lack of trust is profound in minority communities; and bridging enhances the association through culturally appropriate messaging in an effective manner (Policy Link, 2002). Social capital avenues are critical for services that provide quality healthcare access and positive outcomes (Policy Link, 2002). Partnerships are substantial to build an infrastructure that is often missing key variables and requires the involvement of multiple sectors (Policy Link, 2002). Communities through task forces are also able to challenge government authorities and industries on deteriorating environments, and correlation to debilating health (Policy Link, 2002). Community concerns often go beyond that particular region, so it is of utmost importance that attention and connections are also made outside of the community; policies – local, state, and federal often have implications on the community state of affairs (Policy Link,

A highly motivated and dedicated analyst with over two years’ experience in start-up Research Office at Huron Consulting Group. Working on developing Medicare Coverage Analysis (MCA) and study budgets for clinical research protocols in various therapeutic areas such as oncology, cardiology, pediatrics, and internal medicine for multiple clients across the country. A meticulous eye for detail in assisting clients with mitigating clinical research billing compliance risks, by interpreting and applying Medicare/Medicaid coverage decisions and national care guidelines to determine correct billing to insurance providers and research study sponsors. A confident communicator with an emphasis on utilizing the strengths of colleagues and creating an

Obamacare is not universal healthcare. The United States actually has an extension of health insurance coverage that is the program we all call Obamacare. This extension of health insurance coverage is expected to cover an additional 26 million people by 2024. In understanding this concept, what we need to understand fully is that the United States does not have universal coverage. Obamacare does not eliminate uninsurance in America; instead, it cuts the number of people lacking coverage about in half. Even after Obamacare is fully implemented, budget forecasters still expect that 31 million Americans will lack insurance coverage which is a bigger group than the people buying coverage on the exchanges (Vox.com).

The triad of cost, quality, and access has impacted the development of the Affordable Care Act on many levels. The Affordable Care Act aims to improve the quality of healthcare, while maintaining the cost of health care ("Quality of care," n.d.). Under the Affordable Care Act, there is more funding for each state to assist in treating people with chronic illness. The goal is for these patient populations to have high-quality services at an affordable cost (“Quality of care,” n.d.). To ensure that quality of care is provided, the Affordable Care Act requires quality measures to be met in order for organizations to receive reimbursement. Although the United States still needs improvement in providing high quality health care that is accessible

As you mentioned, the ACA has changed the way hospitals receive reimbursements from volume to valued-based incentive system. I learned that a percentage of Medicare reimbursement will be withheld unless hospitals meet benchmark performance measures in outcomes and patient satisfaction. Healthcare analysts are emphasizing that for hospitals to achieve the quality outcomes, a focus on assuring reliable measures, use of evidence-based practice, and skill in care coordination is needed (Jeffers & Astroth, 2013). A shift in the system will require care providers to have a patient-centered focus and experience in team care delivery. Jeffers and Astroth (2013) believe that graduate preparation and an advanced nursing degree are needed to prepare

Clinical business intelligence is a modular and scalable platform that helps the organizations to seamlessly integrate data from multiple clinical and financial system and address the most critical BI and analytical needs. Physicians use the hospital EHR and other clinical IT applications to make decisions and provide excellent care to the patients but recently the physician practice network deployed new EMR along with a bunch of online e-prescriptions and lab applications. The hospital system relates to a statewide health information exchange. The new kinds of data support the physicians and administrators in making clinical and financial decisions. BI clinical also leverages technology partnerships to give organizations the

Part D decreases their out of pocket expenses for prescription drugs for a lot of people. Therefore, a great decrease is recognized by patients with extremely high annual expenses for prescription medication. Though, Part D cost patients with low income more then what they previously paid to its adoption when state Medicaid programs covered them. The legislation that established Part D forbids Medicare from negotiating lower prices with drug manufacturers. As a result of an increase in costs of prescription medications frequently passed to the benefit recipients (Mathews, 2006). The legislation are groups that influenced the final outcome of Medicare Part D.

Nonprofit health care organizations are primary responsible and accountable to the communities and populations they serve. They are legally and ethically bound to do good for the benefit of their communities. Their governing bodies are comprised of leaders from the communities they serve. The earnings and reserves of nonprofit health care organizations are reinvested to benefit the community.(1).

Medicare focuses on medical acute care such as doctors visit, hospital stays and drugs. Also, it focuses on short-term services such as physical therapy after a fall or stroke (U.S. Department of Health & Human Services, 2013). Medicare covers services for long term care such as short stay in a skilled nursing facility, home heath services and hospice/respite care, but it does not cover costs for personal/custodial care such as help with bathing, dressing, eating, etc.. In 2015, Forbes reported that Medicare will pay for some of the costs only if a patient meets the following conditions:

Healthcare in the contemporary United States emerges from a long and sordid history that began in the late 1800s when the fight for universal health care came on the heels of the formation of systems that ranged from rudimentary to comprehensive in various European countries including Germany, Norway, Britain, Russia, and the Netherlands (Palmer, 1999). Most of these programs were formed as “a means of maintaining incomes and buying political allegiance”, as conservative governments, primarily in Britain and Germany, worked to stem the flow of the burgeoning socialist and labor parties (Palmer, 1999). During this same time brought a greater transparency of the experiences of industry workers and the “nightmare” conditions they were enduring

Who are Medical Billers and Coders? Medical Billing and Coding Specialist (MBCS) are the invisible engines of the healthcare system. They create invoices for all medical costs provided by healthcare providers and then submit the claims to patients’ insurance companies. They are also responsible for collecting co-payment s for a portion of the healthcare costs. A medical biller is responsible for processing insurance claims so the physicians and office staff get paid. Medical billing is done in a hospital, clinic or physician office. A medical coder work with ICD-9-CM, CPT, HCPCS, and/or ICD-10-CM medical codes making sure the procedures don for that patient are consistent with the diagnosis in the patient’s chart.