Centers for Medicare and Medicaid Services

hospital surveys (Salvucci, 2015). The introduction of value-based purchasing by the Centers for Medicare & Medicaid Services’ (CMS), implemented a program in which participating hospitals are paid based on the quality of care of the services the patient received (Hospital Value-Based Purchasing, 2015). Therefore, if hospitals want to recoup benefits from Medicare and Medicaid, excellent care and services must be provided. Therefore, Methodist Olive Branch along with our parent system,

has Medicaid. This limits his options on coverage and who he can go to. He has a condition that needs medical attention, high blood pressure, but because of his insurance he is finding it hard to get the care he needs. Many people have that problem but there are solutions to get the care you need. John lives in a rural area that doesn’t have any primary care doctors that take his insurance. He was able to find two doctors in his area but not a

improve his health and well-being. This is the harsh reality of the long-term care industry that many have faced, including experts in the field such as Dr. Robert Kane, author of It Shouldn’t Be This Way: The Failure of Long-Term Care. Long-term services and supports (LTSS) are supposed to maximize the quality of care and the quality of life for the individual (Kane and West, 2005, p. 169). When that focus is lost, it is the responsibility of healthcare professionals, like myself, to bring that issue

Care Options: Paper 1 Don and Mary Long term health care and end of life care is a reality that is usually inevitable. “Research shows that at least 70 percent of people over 65 will need long term care services at some point in their lifetime” (Centers for Medicare and Medicaid Services, 2012). There are many decisions that people must make in the event. Don and Mary are a married couple who have to make that decision. Don and Mary served together in the military. After the military they both

unconstitutional for the federal company to force Medicaid expansions on the states (6). This resulted in Florida choosing to omit themselves from the expansion. These expansions of Medicaid would have provided 800,000 uninsured Floridians with insurance (6). This would have given roughly 4 percent of the population of Florida insurance alone. The state of Florida turned down 50 billion dollars of federal money that would have helped expand the Medicaid program. This federal funding would have targeted

improving the quality of hospitals. The Hospital Quality Alliance (HQA) program that is overseen by and public and private entities, that include the Centers for Medicare and Medicaid Services (CMS) as well as the Joint Commission, is dominating this effort in the hospital district, generating reports quarterly on the delivery of effective services for mutual conditions. Even though the Hospital Quality Alliance has made this data more available to the public, there has not been enough information

result in extensive fines and fees, running up into the thousands. Furthermore, depending on the seriousness of the situation, deliberate verse accidental, it can result in the loss of participation in government healthcare programs, such as Medicare and Medicaid. To make matters worse, it is ridiculously easy to prove it; all the government needs to do is show that violation has occurred (Caesar, 1996). In Dr. Brown’s case, he was running late, patients had been waiting over an hour, and he simply

pain assessment of patient reporting pain. The Affordable Care Act (ACA) (2010), also titled the Patient Protection and Affordable Care Act H.R. 3590, was passed by Congress and signed into law on March 23, 2010 (U.S. Department of Health and Human Services (DHHS), 2013). Hospital value based purchasing programs (VBP) were developed to align patient quality care and outcomes to the support initiatives from the ACA. A component of the VBP includes patient satisfaction. Patient satisfaction is a self-reported

(1) How does incorrect patient information impact a claim? Responsible coder collects post and manages account payments, submitting claims and keeping in touch with insurance companies. If patient information is coded incorrectly, or incomplete it could leave an impact that can be brought to a claim. Inaccuracy in patient information can lead to denials, none payment and investigation. It is important to get all the details right by verifying insurance coverage properly. Make sure that the patient’s

amendment to title XVIII of the Social Security Act, to add a new Medicare Condition of Participation (Cop) for hospitals and critical access hospitals (CAH)’s requiring them to provide written notice as well as an oral explanation of the written notice to patients who are entitled to Medicare and for those hospitals are billing Medicare (Public Law, 2015). This notice which, is known as the Medicare Outpatient Observation Notice (MOON), has to be presented to the patients that