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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
Pacing is the rate of action in which we put a plan into action. In accordance with Kotter who speaks to an eight step sequencing plan. The order in which your procedures are implemented is sequencing. (Kotter’s 8 step plan)
is admitted to is Medicare certified, Medicare Part A will pay for 100% of her
The terminology (i.e., Federal health care programs) contains any program that provides medical benefits, even if directly, by means of insurance, that is paid directly, in full or in part, by the US Government (i.e., Through programs such as Medicare, Federal Employees Health Benefits Act, Federal Employees’ Compensation Act, the Longshore and Harbor Worker’s Compensation Act) or any State health plan (e.g., Medicaid, or a program receiving funds from block grants for social service plan requirements. Guidelines, an industry should have
An example of this Act is the very popular Nancy Cruzan Case. Although Nancy was left in a vegetative state resulting from a car accident, her parents were able to make the decision to have her removed from feeding tubes because Nancy expressed before the accident that she never wanted to be kept alive from breathing or feeding tubes. This Act really promotes Advanced Directives and hospitals, clinics and other providers that receive Medicare or Medicaid funds to provide patients with written information about their right and the information must clearly state the institutions policies on withholding or withdrawing life-sustaining treatment.
Healthcare facilities are required to maintain licensure, certification, and accreditation in order to receive payments from federal government programs such as Medicare. Healthcare facilities must meet the minimum standards in order to operate, such as sufficient staffing, personnel employed to provide services, the quality of equipment, buildings, and supplies, and services provided, including health records. (LaTour, 2013) Medicare has developed Conditions of Participation and Conditions for Coverage, which identifies specific criteria that must be met in order to receive reimbursement from Medicare. Medicare implements these guidelines in order to
In response to the “Patient Protection and Affordable Care Act (ACA) amended by the Health Care and Education Reconciliation Act (Reconciliation Act), collectively referred to as healthcare reform” (); Wishard-Eskenazi Health of Indianapolis, Indiana has begun to make milestone changes to meet the requirements of the healthcare reform. Being a leader in today’s technology which began thirty years ago with development of one of the nation’s first electronic medical record and continues to excel in the healthcare informatics technology today continues to use this technology in quality improvement initiatives, support for future technology research and improving the quality care of the patient.
Comprehensive Primary Care Initiative will help the patients with more serious or chronic conditions, follow care plans personalized for their needs. (CMS,2014).
insurance for Americans that are aged 65 and over and younger people with disabilities. It was the
Families that do not qualify for the public health insurance, Medicare, in the U.S., their
* Medicare/Medicaid, to be sure the doctor is not banned from caring for Medicare/Medicaid patients
Throughout the early 1980’s and 1990’s the Federal Medicaid program was challenged by rapidly rising Medicaid program costs and an increasing number of uninsured population. One of the primary reasons for the overall increase in healthcare costs is the
“The Association of American Medical Colleges expects a shortage of up to 31,100 primary care doctors and up to 63,700 other physicians by 2025”(Consumer Report, August 2015). NPs are capable to conduct physical exams, diagnose, treat illness, prescribe medication (not all), order and interpret tests, counsel a patient and perform surgery with assistance. In 18 states, NP are performing majority of primary care and able to treat minor illness without a physician supervision and It would be beneficial if the other state get on board of having an NP fill the gap.
The purpose of this paper is to give an overview of two federally and/or state funded programs. The programs that will be discussed are Medicare and Medicaid. In this paper will be information about who receives Medicaid/Medicare, the services offered by these programs, and those long term services that are not.
Medicare is one of the most widely acknowledged sources of health insurance coverage in the United States. It is often complemented by Medicaid, a similar health welfare program that includes children and the poor. Many Medicare beneficiaries are "dual eligibles" who use Medicaid to extend comprehensive inpatient and outpatient health care coverage, especially for prescription drugs, diagnostic and preventive care, and eyeglasses which fall outside of Medicare. Medicaid can also supplement Medicare deductibles, premiums, and up to 20% of uncovered charges (Goodman, 1991).
Specific coverage and benefit details vary from state to state (Raffel, 224). This is intended to help people with high medical costs that are not old enough for Medicare.