who are admitted to Non-VA facilities. There are two phases of this scholarly project. The first phase will focus on conducting a retrospective chart review from July 2016 to September 2016 for all Veterans who is admitted into Non-VA facilities. During the second phase of the scholarly project, one will evaluate the current practice and perform a comparative analysis of Chronic Care and Transitional Care Models with the evidence from literature search.
health care services procedures and facilities according to evidence-based criteria or guidelines, and under the provisions of an applicable health benefits plan. Typically, UM addresses new clinical activities or inpatient admissions based on the analysis of a case, but may relate to ongoing provision of care, especially in an inpatient setting. UM describes proactive procedures, including discharge planning, concurrent planning, pre-certification and clinical case appeals. It also covers proactive
According to Buchbinder & Shanks (2012, p. 204), cash budget defined as “the necessary step that allows the organization to determine how to optimize the value of the cash being generated by its operations. More interestingly, this also defined as a forecast of cash inflows, cash outflows and net lending and borrowing needs for the months ahead”. From the point of what I understand the discussed definition of a cash budget, it looks like similar to operating budget however, there is a certain difference
Reimbursement of medical services is often challenging for mid-level providers such as nurse practitioners (NPs), in family practice (Enos, 2016). Several factors can affect NPs when submitting for care compensation, which may include the credentials of the clinician, inappropriate billing and coding, and unreflective documentation. NPs can express medical services through “incident-to” or independent billing for third-party payer claims such as Medicaid, Medicare, and private insurance companies
physicians will increase 14 percent from 2010 to 2020—while primary care physician supply will increase by just 8 percent (U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis) —creating greater demand for interdisciplinary, team-based approaches to deliver primary care services (Doherty RB & Crowley RA, 2013). Pharmacists are increasingly providing direct patient care based on state scope of practice regulations in a
assure quality of care (Carroll, 2009). This analysis will evaluate the Det Norshe Veritas, Inc. (DNVHC) accreditation. This program is recognized by the Center for Medicare and Medicaid Services (CMS). This program serves as a condition to support reimbursement from Medicare and Medicaid for services rendered. This analysis will discuss the benefits of achieving accreditation and discuss differences between global and national standards. The analysis will conclude with a discussion on retaining
variety factors that prevail in a location, including state and local licensing laws, reimbursement structures, availability of medical personnel and facilities, and the demographic details (such as age and industrial distribution) of the potential patient population. The unique aspect of the health care industry from an audit perspective is the health care delivery system – the revenue cycle.
recovered billions more dollars. The Centers for Medicare and Medicaid services has tied payment to quality standards, invested in patient safety and have offering incentives to providers who deliver high quality, coordinated care. Hospital reimbursements are now tied to performance on quality metrics, as well as patient experience. All part of the value-based payment system (The Centers for Medicare and Medicaid, ). The
Healthcare Reimbursement Models…. Is There a Better Way? Physician Perspective Executive Summary The traditional methods of paying for healthcare services use to involve paying for services out of pocket. The gradual transition from fee- for- service payment to managed healthcare is not a recent phenomenon. With the increasing costs of healthcare services, there was an increased interest in moving payment from fee-for-service into a more organized payment structure. This paper discusses
Summary Escalating healthcare costs, decreased reimbursement rates, and increased emphasis on the patients perception of care have hospitals researching methods to improve quality metrics ad maximize reimbursement. One such intervention is multidisciplinary rounding (MDR). The research question addressed in this research summary and table is: “In hospitalized patients, will a unit’s initiation of bedside MDR increase patient satisfaction and decrease patient length of stay, within 6 months of introduction