Healthcare Ecosystems

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HEALTHCARE ECOSYSTEMS

Healthcare Ecosystems
RLTT: Task 2

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HEALTHCARE ECOSYSTEMS

PACE and Telemedicine
All-Inclusive Care for the Elderly otherwise known as (PACE) is a benefit program provided by the Centers for Medicare and Medicaid Services (CMS) for patients that are 55 and older and can be nursing home certified. CMS works with state administering agencies to operate a PACE program in their respective state. PACE is only provided by states that choose to offer the program under Medicaid provisions. PACE is a benefit provided by Medicare and is optional with those having Medicaid. As one of the only programs that combine Medicare and
Medicaid, the PACE objective is to keep the patient living in their communities
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The new ICD-10 coding system gives more specific choices for diagnostics and will ensure services are paid appropriately to reduce fraud and overpayments.
The transition from ICD-9 to ICD-10 is required for everyone covered by the Health Insurance
Portability Act on October 1, 2014. According to the Health and Hospital Systems Secretary,
Kathleen Sebelius, “The new healthcare law is cutting red tape, making our health care system more efficient, and saving money”.
Standards
The standards set for the PACE program are very stringent. The certification process requires and application, on-site visits, and information provided by the state agency. The application process can take up to nine months and once accepted, the first three years are considered a trial period. Within the trial period, the PACE program is reviewed annually by the state administering agency to ensure compliance with the federal regulations and every two years after that. Compliance is vital to maintain participation in the PACE program. Any violation of the regulations will bring about suspension of enrollment of beneficiaries, penalties, and/or suspension of payments. The PACE program basic requirements state that it must be able to provide a complete healthcare service regardless of the amount of care needed or the time a service takes (PACE- fact sheet, ). Telemedicine offers a way to provide service and is growing in importance as part of the complete

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