Provider Information Technology At The 21st Century

There is a growing trend where physicians are choosing different specialties instead of choosing primary care, primarily due to the low reimbursement rate in primary care. According to Iglehart (2014),” the Association of American Medical Colleges (AAMC) still projects a shortage of 130,000 physicians by 2025, split almost equally between primary and specialty care” (para. 1). With this decline comes an answer, an increase in the number of nurse practitioners providing patient care, reported 154,00 in 2012 and growing every year (Iglehart, 2014). This increase in nurse practitioners’ helps fill that gap, allow greater health care access to the community, especially special populations. By gaining access to healthcare were a nurse practitioner is the provider not only with the special population have high quality affordable health care, a trusting long lasting relationship will develop. This relationship will break the barriers of; lack of trust, lack of health care education and discrimination. Nursing is a trusted profession that provides education and care that no other health care professional

Step 1- Register Patients/ Check In - You can do this either when patient calls to set initial appointment and ask for their insurance information via phone to confirm prior to appointment. You can also at this time ask them to fill out paperwork prior if it is available via email or company web page. When patient comes in ask for insurance card for your records, along with any documentation that is needed. Example Referral or Prior Health Records.

Appointment/Registration - This determines whether an individual is an established or new patient; if the patient is new, then insurance information is obtained and verified to make sure that the patient qualifies to receive services from the provider.

The negative impacts of healthcare reform to health systems are significant in that health systems are preparing their resources on developing Accountable Care Organizations (ACO) for bundled payments and population-based reimbursement. In this economy the impact to health systems may require healthcare systems to figure out ways to continue to keep positive financial performance due to the cost-reduction of healthcare reform. For some time now, health systems have subsidized their losses from the Medicare and Medicaid systems by contracting with commercial payers for their premium rates. As a result of the healthcare reform, cost shifting will shrink. Another negative impact over the next few years will be the large shift in health plan enrollment. Less people will be covered by highly

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.

Three issues or trends I see that are important with regard to credentialing are reimbursement, malpractice and education. Within each issue are opportunities for the advance practice nurse (APN) to grow in knowledge and participate in change. It is important to understand why each one effects credentialing for the APN.

“A Council on Graduate Medical Education document anticipated that there had, “been 242,500 PCPs within the United States in 2010, and nearly 25% (55,000) of them aged ≥56 years. The common reimbursement for PCPs is approximately only 55% that of other scientific specialties, main to a cumulative lifetime internet income gap of about $ 3.5 million per primary care physician” (Collins, 2012). This makes being a primary care physician less desirable since the incentive is so low. A similar associated issue is the very low percent of medical institution students who are choosing to become primary care physicians. Another issue is that about 59 million Americans live in regions with health professional shortages. Shortages in a number of other primary care healthcare specialists exist, especially with nurses. “In 2014, US schools turned away almost 70,000 qualified nursing applicants because they didn’t have the capacity for them. In fact, almost two-thirds of surveyed nursing schools cited faculty shortages as the reason for not accepting all qualified applicants into nursing baccalaureate programs” (Erickson, 2016). This greatly contributes to the shortage of nurses if they cannot receive proper education and training to join the workforce. Many healthcare service professionals shortages are in regions within

The state healthcare marketplaces have increased new insurance companies in their markets and many of these state healthcare marketplaces will increase new health plans as well. These additional physician opportunities will be imperative for them to understand how the contracting process affects their practices.

Preferred provider organizations offer flexibility in benefit design and allow patients flexibility to choose from a list of in-network providers for their care. Care provided in-network typically is discounted with out of network services resulting in higher out of pocket expenses to the patient (Hirth, Grazier, Chernew and Okeke, 2007). Clinically integrated networks are a more recently developed managed care structure. In this model, independent practitioners form a virtual network as a means of increasing capacity for contracting with payers of healthcare whether commercial insurance or for self-insured organizations. Physicians recognize advantages to collaborative contracting and the increase in coordinating care of patients through the network (Kaplan and Guest, 2012). Commercial insurance companies are looking to clinically integrated networks as another mechanism to control the costs of healthcare delivery. Accountable care organizations, as with clinically integrated networks, are fairly recent phenomenon with similar but more formalized characteristics. An accountable care organization is a structured network of healthcare entities which have united and are responsible for the health of an identified population. The accountable care organization shares the risk of meeting the health needs of

Healthcare reimbursement systems within the United States are a complex structure for obtaining payment for services rendered. The healthcare system officers are required to understand the ordinary principles of the payer system. Understanding the rules, and keeping up with the continuous changes will allow the providers, physicians, and facilities to gain an advantage in this growing healthcare domain. Both private and commercial insurance companies provide a diverse menu of choices to customers. All third-party payers create interest in decreasing healthcare costs and improve control access to the not needed services. This paper will address the complexity of the healthcare reimbursement systems in the United States. Additionally, the research

Today, the United States is facing a shortage of about 16,000 primary care physicians and this number will continue to grow by 2025 (Amirault, 2014). Primary care physicians (PCPs) are the doctors who focus on overall health and offer the treatments and preventive screenings that save lives. A physician shortage is a situation in which there are not enough providers to treat all patients in need of medical care. The Association of American Medical Colleges (AAMC) has long pointed out that the shortage of primary care physicians will be a major setback for the American healthcare system advancing (Amirault, 2014). The shortage of primary care providers presents

“Nurse practitioners were created in an environment of informal training, a lack of credentialing processes, increasing sophistication of medical care, and opposition” (Medscape). In 1970, Nurse practitioners stated that patients were pleased with their improved convenience of health care services. In the early 1980s, health care encountered challenges to clarify their scope of practice and nursing organizations offered titles and certifications to meet federal regulations for reimbursement (Medscape). Nurse practitioners faced several barriers to gain provider status and needed direct reimbursement to practice as independent health care providers. An aggressive campaign was created and nurse practitioners achieved legislation over 20 years, resulting in provider status in 1997.

Time, money, and accountability, are exceptional evidence based practice barriers. Along with those three examples, increased responsibility is additionally attributing as many health care organizations are expecting all staff to “working to the top of licensure”. The transition is maximizing to decrease expenses, offset hiring, and provide exceptional quality patient care among team member assets. This not only affects current registered nurses scope of practices, but also those pursing advanced degrees such as nurse practitioners including state by state regulations. On April 25, 2017, an email was sent out from Wisconsin Department of Safety and Professional Services, reaching out to all registered nurses in the state of Wisconsin

The best health care systems in the world offer integrated care. Systems like the Mayo Clinic and Geisinger Health System own hospitals and labs and employ all the physicians and nurses a patient is likely to see, so they can easily integrate a patient’s care. In contrast, patients in North Carolina and throughout America typically obtain their care from a variety of independent providers. Health care expenses are paid by a variety of sources including private insurers, employers, the government and patients themselves. But unlike any other state, or even any large geographic area, North Carolina has the capacity to create a “virtually” integrated system, one that can provide the same integrated care but across an entire state. When patients’ transition between providers and health care settings, the result is often poor health outcomes, medical errors and costly duplication of tests and procedures. Through partnerships with other organizations and providers, NCHQA is seeking ways to better coordinate care and address systemic problems that cause dangerous and costly gaps in care. (NCHQA, 2014)

Hospitals and health systems in the U.S. are experiencing a remarkable transformation in their business models directed from numerous influences that are projected to ultimately turn the industry around. Pressures include providers troubled with the quantity of services they are responsible for, to providers who concentrate on presenting high-cost services that give emphasis to sustaining healthy populations (Dunn & Becker, 2013).