Reimbursement Model In Health Care

In 2009 The American Recovery and Reinvestment Act (ARRA) allocated approximately $19 billion to support physicians and hospitals in attaining meaningful use of health information technology (HIT). The meaningful use program is intended to facilitate providers to amass

Cost reduction could impact the quality and efficiency of health care by using information technology (IT). It was a federal policy initiative to increase the outcome of patient’s health (Jacobs, 2012). It was for hospitals to increase the use of technology to assist to manage expenses. It ended up improving the

In my role with Liberty Mutual, I drove adoption of Medicare reimbursement models through public affairs involvement with multiple state workers' compensation committees seeking to update their reimbursement schedules in response to the implementation of ICD-10 coding requirements in October of 2015. With the state workers’ compensation authorities seeking to adopt CMS reimbursement type models, my involvement was directed at securing the inclusion of specific CMS rules governing correct coding and reimbursement practices including National Correct Coding Initiative Guidelines (NCCI), Medical Unlikely Edits (MUE), along with the Resource Based Relative Value System (RBRVS) for reimbursement rate setting.

“The Tax Equity and Fiscal Responsibility Act (TEFRA), signed into law September 3, 1982, mandated the development of a prospective payment methodology for Medicare reimbursement to hospitals.” http://sunlightfoundation.com/blog/2009/09/08/slug/. It changed Medicare reimbursement from a fee for service to prospective payment system. Which is where there`s a reimbursement method where`s there an amount of payment determined in advance of services being performed. The rates are done annually. Reimbursements for inpatient care by a classification scheme called diagnosis-related groups. If the patient might have to stay longer in inpatient care more than average days, the hospital may lose money on that patient.

Information Technology can be use to address escalating health care costs, reform payment systems, reducing health care disparities, and can be effective in comparative research (). In this next section will discuss how these recommendations fit or not fit with the initiatives of the ACA.

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

The United States health care system has can be assessed for quality measures in many different ways such as mortality rate or infant mortality, but the United States government often judges the efficiency of health care provider or network on the Centers for Medicare & Medicaid (CMS) core measures. The reason the United States gauge health care performance on CMS standards is due to CMS is the federal governing body that operates Medicare and how the hospital will be reimbursed from Medicare patients. Formerly Medicare would reimburse a hospital based all services the hospital provided a patient or fee for service (FFS). The rising

A current problem in the advanced practice roles is reimbursement for Medicare, which “is set at 85% of the physician rate, a payment disparity that the APRN community has quietly accepted” (Mason, Leavitt & Chaffee, 2014, p. 396). An example of this is evident through ear infection visits in the office. When a patient comes in for otitis media their reimbursement is “15% less than when the same condition is treated by a physician” (Mason, Leavitt & Chaffee, 2014, p. 396). MedPAC an independent advisory commission called The Medicare Advisory Payment Commission has suggested that there should be no payment differentials between providers (Mason, Leavitt & Chaffee, 2014). However, still advanced practicing nurses still do not receive the same amount of reimbursement for the same services rendered.

I think that reimbursement system is one of the most important implements to maintain managed care organization. However, there are various models accessible to manage hospitals or health care associations to keep track of reimburse payment methods. As of carefully reading through the book, I believe a basic model of reimbursement includes Fee for services, capitation, and salary. However, each of these models is states differently and approached it differently.

There is a constant change and upgrade in technology that is being used not only in the Healthcare setting but in everything we have and everywhere we go. Since healthcare is a big business, the healthcare fraud and abuse is becoming a national issue. We should be aware of it in order to avoid such abuses and fraud.

The government influences the delivery of healthcare by setting forth several different requirements. As with any state or federal agency, licensure of both the facility and providers are required (Gartee, 2011). In addition, there are certain standards that must be met by the facility in order to participate in government funded programs. The most widely known programs within the healthcare industry are Medicare and Medicaid.

The outcome is that many low-income adults and other Medicaid beneficiaries continue to suffer from pain and discomfort of tooth decay and gum disease. Eventually, at some point, patient may need to go to expensive emergency rooms, where they can do little but provide temporary pain relief. Consequently, untreated oral diseases can increase anxiety and may worsen other health problems, such as heart disease, diabetes and rheumatoid arthritis (Choi, 2011).

The goal in healthcare today is to achieve better patient outcomes. Technology is changing daily that affects how patient care is provided. As the world around us continues to move into a more advanced technology based healthcare system incentives are offered to qualifying healthcare entities, provided they are utilizing approved health information technology (IT) to comply with standards set by the Centers for Medicare & Medicaid Services (CMS) (Jones, Rudin, Perry, & Shekelle, 2014). Standards such as meaningful use help ensure with the use of electronic health records (EHR) that patients are receiving quality care (Centers for Disease Control and Prevention [CDC], n.d.). This paper will define and discuss the importance and implications of meaningful use relating to healthcare. Several key points will be discussed including an overview of meaningful use, analysis, further recommendations and a conclusion.

There are many medical practices, facilities, and agencies have found that nurse practitioner (NP) and physician teams are key to providing high-quality and cost-effective care. After working diligently in providing patient carte there must be a reimbursement such as a fee-for-service. There are many entities like the public, private and managed health care plans that may regulate the reimbursement processes or each state. The public insurance costs less than private insurance is that payment rates for health care providers are typically lower. Another aspect to understand in what differentiate those types of payers the private insurances do not offer dental or vision care, services that are important for children, and some low-cost private

When we received the insurance reimbursement, we always deposit the check to revenue account. We never deposit the check to the expense account. Maria deposit the check into the correct account. If there is any expenditure on vehicle repair, please let me know. I will do the budget amendment to offset the repair