Personal Narrative: My Experience With KP Patients

The health care system in the United States is known for being one of the most costly systems in the world. In 2010 the Affordable Care Act, (ACA) was implemented with the hopes of reshaping the system and decreasing the healthcare cost, (Mason, Gardner, Outlaw, O’Grady, 2016). . Somewhere along the way our country made healthcare a business. Understandings our country healthcare finances can be quit complex. In order to be successful the Chief Nursing Officer, (CNO), business owners and directors must understand the business principles. These individuals are placed in leadership role and therefore must have the characteristics of a leader, (Huber, 2014)

Obtaining reimbursement for services provided is a necessity for the survival of many health care organizations. This paper will explain, in my opinion, why the Centers for Medicare and Medicaid Services (CMS) are involved in this development and how it affects the American public. I will offer a suggestion to ensure meeting policy and procedure. I will finish by discussing three ideas listed on the CMS website.

The first piece of legislation (one legislation I discussion 2 pieces of that) discuss is section 101 part of Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), a bipartisan legislation signed into law on April 16, 2015. This law was created to replace the current law in that time Medicare reimbursement schedule with, the revolutionary idea of new program supposed directed focus on the quality, value and accountability of the national health care program. The CMS describe MACRA as a modern system new payment framework, supposed rewarded the national health care providers to obtain the better care instead of more service, looking for value over volume. The information’s observed in the interview provides consistent points

When Medicare was first established, Medicare adopted the payment methods of Blue Cross Blue Shield which meant that the program was paid hospitals on the basis of their own costs and physicians were being reimbursed by the fees that they charged which caused hospitals and physicians to provide care without boundaries (Anderson et al., 2015). This method caused Medicare to dissipate the budget that was established for beneficiaries to utilize. Now, with the ACA being implemented, Medicare had done an overhaul of payment reimbursement. Medicare is now moving toward a volume to value payment initiative that links payment to patient outcomes, experience of care, while giving providers an incentive to limit spending

In today’s seemingly ever-changing world of healthcare regulation, medical professionals are burdened with many compliance requirements. On October 14, 2016, the Department of Health and Human Services released its final rule implementing the Quality Payment Program as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Starting January 1, 2017, clinicians who are reimbursed by the Centers for Medicare and Medicaid Services(CMS) are required to participate in the Quality Payment Program (QPP). (Centers for Medicare & Medicaid Services, 2016) The QPP replaced the Sustainable Growth Rate formula with the new payment structure in which clinicians are rewarded for delivering high quality care. There are now two pathways for

The DOJ and HHS created the Stop Medicare Fraud website, which provides information about how to recognize and protect against Medicare and Medicaid misrepresentation and how to report it. In conclusion, the government has moved away from the inefficient and costly fee-for-service payment type and moved toward the value-based reimbursements for health services to help increase patient care and quality outcomes. I believe the FCA and AKS regulatory laws are able of guarding against overutilization, raised costs, and poor quality of care and I look forward to this being debated in the

While there is still much to learn about financial operation of a health organization, I feel that I have better understand of most of the fundamental principles that apply to a broad spectrum of businesses. Upon reflection this understanding of financial principles also reinforces the need to have a fundamental base of knowledge, but simultaneously services to illustrate the vast body of information that there still is to learn. The allied health community assignments were useful in a general sense, in that they allowed a student to apply some of the concepts that they have learned. This “hands on” approach was helpful because it added context to the lectures and readings. As an exercising in doing the work of an administrator, the allied health community exercises required the student to research additional information about the topics assigned and this allowed me to further mentally cement the concepts.

However, the quality of these services seems to need improvements as better services to patients and proper care for health will impact the revenue cycle and reimbursements. Obama-care supporters are making the false impression that new government rules would promote opposition, control costs, and advance the quality of health care delivered within Medicare. Believing that, implementing this method would concurrently regulate the growth of Medicare costs in a more rational fashion and close the gap of health care we currently have and the health we would have in our future. No matter what department is seeking insurance reimbursement, accurate documentation is required along with proper billing codes to receive timely reimbursement.

The report on Medicare spending provides relevant information about the United States healthcare system. It further provided ideas of how the U.S healthcare system is using drastic measures that limit cost, increase quality of care and focus on patients’ care. From the report, it appears that the U.S federal program Medicare had reduced its spending to 0.2% in 2013 as compared to 1.8% between the years 2009-2012. The article supported its claims of Medicare spending reduction by citing statistical data from Medicare budget reports. As mentioned in the article, the decrease in spending could have resulted from the recent recession (hardship limit spending), Medicare wide range of delivery system reform to implement quality at a local cost or

HCA, after following a conservative financial policy since its establishment, has entered the new decade preparing to make some changes in order to realign their financial strategy and capital structure. Since establishment, HCA has often been used as a measure for the entire proprietary hospital industry. Is it now time for the market to realign their expectations for the industry as a whole? HCA has target goals which need to be met in order to accomplish milestones in the future. The problem arises as to which area holds priority to the company. HCA must decide how the key components of their financial strategy and policy should my approached in order

Centers for Medicare and Medicaid Services (CMS) had adopted the “no-pay” rule in the year 2008 with the objective to encourage hospitals to terminate medical complications (American Medical News, 2012; Stone, et.al., 2010). Under this rule, CMS denies the payment to the healthcare facilities for any extra cost which is involved in treating Medicare patient. This policy has the significant impact on the health care system as the hospital executives need to redefine their priorities and enhance their efforts towards improving patient care.

Many doctors see this as a decease in payments, howeve,r according to CMS Medicare PCIP payments for 2011 exceeded 560 million. Medicare patients’ are being turned away, strangely enough doctors are refusing to accept patient with Medicare insurane. As doctors become more frustrated with Mnedicar’s reimbursement rates and rules, many are displaying their dissatifaction by not treating Medicare Patients (Bengel, 2013). Although, it is believed that the decline in of Medicae is on a production of possibility

Healthcare is one of the largest growing fields with increasing demands every day. In the past, healthcare was thought to be a work force of doctors, nurses and other medical staff but it has evolved into a large industry with a need for managers and administration. This management and administration has brought a new skillset to the field that strongly interests me. I spent the first two years of my undergraduate education in pharmacy school but through my many job shadows I fell in love with the business side of the health industry. I became fascinated by healthcare administration because of the potential opportunities such as: the ability to combine my talents of leadership and organization with my passion of health; the capacity to analyze and predict future trends to help my organization stay ahead therefore becoming a leader in industry; and the capability to understand medical professionals and their skills to lead and direct them in ways that will create a super-team.

At no other time in history have providers had to cope with a payment system in which their patients are the biggest payer class. This shift has required physicians to adjust their payment strategies significantly to stay afloat.

This week I had rotation at Genesis and also Cumberland Hall. Genesis was very different that what I expected. When I think of a “rehab” I think of people all sitting around with major withdrawal symptoms, a very strict schedule, multiple one-on-one session, and with no smoke breaks. At Genesis, throughout the day the client was able to do their own thing until the scheduled group session and smoke breaks. I was placed on the male unit and I was very surprise of the self-awareness that I experienced. Just listening men talk and tell their stories brought on a whole new prospective and quickly changed the image of the addict stereotype. While I was there we also established that all the clients was first timers and all fathers, and afterwards I was able to sit and think about how grateful I am to have my father who’s not an addict. I have had the luxury of always having a clean and sober father; which I had taking for granted.