...University of Phoenix Material Health Services and Systems Matrix Choose at least seven services or systems from the following list: • Hospice care • World Health Organization (WHO) • Public health • Rehabilitation center • Department of Health and Human Services (DHHS) • Medicare • Centers for Medicare and Medicaid Services (CMS) • Center for Disease Control (CDC) • Health Maintenance Organization (HMO) • Occupational Safety and Health Administration (OSHA) • Joint Commission on Accreditation of Healthcare Organizations (JCAHO) In the following table, describe each of your choices and explain their functions and roles within the health care field. Your responses should total at least 50–75 words for each choice. |Service or System |Description |Function |Role | |Hospice Care |To care for a person who is in |To manage the pain and symptoms of |To make the patient as comfortable | | |their final stages of an incurable |the patient when other methods are |as possible who is facing the end | | |disease. |no longer working. |of life. | |Public Health |A science, which deals with |To monitor environmental and health|To educate people about the daily | | ...
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...on a daily basis. How has it come to be this way? There could be many reasons. One could argue that the introduction of Medicare and Medicaid contributed tremendously to Parkland's growth. Before 1965 Parkland Hospital has always seen a steady growth, but shortly after the signing of Medicare and Medicaid into law in 1965, there was a sudden spike in growth activity within Parkland's organization. This growth could have been contributed to the influx of money coming in from medicare payments going to the hospital. Three years after the Medicare and Medicaid was signed into law beginning from 1968 through 1973, Parkland opened 9 new specialty care units. In 1978 Parkland had to form a patient care committee to review Medicare and patient services studies and to look at ways to ensure Parkland's long-term viability (Parkland, 2014). At this present time Parkland hospital has 861 adult beds, 107 neonatal beds and a number of clinics in the surrounding neighborhoods . They see a combination of indigent, elderly, psychiatric and inmate patients everyday. According to Parkland's 2013 financial summary about 42 percent of insurance payers came from Medicare and Medicaid payers (Parkland, 2013). That was close to half of Parkland's patient population. Earlier in 2011 the Centers for Medicare and Medicaid services threatened to cut off Parkland's Medicare and Medicaid programs. This would have put the organization at the risk of loosing $462 million a year in payments (Hethcock...
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...Medicaid/Medicare Services Stella Williams Harrison College Medicaid/Medicare Services Develop a plan for the center by using clinical quality measures, or CQMs, which are tools to help track and measure the quality of health care serviced that are provided by eligible professionals, eligible hospitals that are within the health care system. These would be measures to use data that is associated with providers that are able to provide high quality care or relate to long term goals for health care. The measures would be the many aspects of patient care including: * Health outcomes * Patient safety * Clinical processes * Efficient use of health care resources * Population and public health * Adherence to clinical guidelines * Patient engagements * Care coordination By reporting and measuring CQMs in a three month or 90 day reporting period will help to ensure that the health care system is safe, efficient, effective, patient centered, timely care and equitable. According to the EHR Incentive Programs the need to report the measures will demonstrate meaningful use and receive an incentive payment so the CQMs may be reported electronically or via attestation. The CQMs are identified into core sets and they are highly recommended so the focus can be on conditions that contribute to the morbidity and mortality of most Medicare and Medicaid beneficiaries with some factors that would be recommended, the Center would have to have certain conditions...
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...be discussed are Medicare and Medicaid. In this paper will be information about who receives Medicaid/Medicare, the services offered by these programs, and those long term services that are not. Medicaid Medicaid is a joi8nt federal and state program. It provides health coverage to nearly 60 million Americans including children, pregnant women, seniors, and individuals with disabilities. As well as those people who are eligible to receive federally assisted income. Eligibility does however vary state to state. Medicaid may help pay for: Doctor bills, hospital bills, prescriptions, vision care, dental care, Medicare premiums, nursing home care, personal care services, in home care under the community alternatives program, mental health care, and services for children under 21. Medicaid can help pay for cost and services that Medicare doesn’t cover. In most states, Medicaid will pay for long term care services. In most instances they will cover services that will help and individual stay in their home such as personal care, case management, and help with laundry and cleaning. They won’t however pay for rent, mortgage, utilities, and/or food. Medicare “Medicare is the federal health insurance program for people who are 65 and older, certain young people with disabilities, and people with End Stage Renal Disease requiring dialysis or a transplant, and sometimes ESRD.” ( medicare.gov). There are four parts of Medicare that cover specific services: Medicare Part A, Part B, Part...
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...Affordable Care Act Obamacare The Affordable Care Act also known as Obama Care is the most significant health care legislation enacted since the beginning of Medicare and Medicaid forty five years ago. The Affordable Care is one that is very confusing and least understood. I think most Americans understand that all Americans will need to get health insurance in some way, but Americans don’t really know much else about this law. This act will not benefit everyone, however those who were previously uninsured or underinsured will benefit the most from the act. Also, those previously denied health coverage because of a pre-existing health condition may now be insured. While the Affordable Care Act is a federal law, the details of how it’s implemented are much left up to the local state government. Many Americans will not benefit from the Affordable Care Act because they fall under a coverage gap meaning that they live in states that do not have expanded Medicaid coverage, they make too much money to qualify for federally sponsored insurance, or they not old enough to qualify for Medicare yet. Nationwide about three million uninsured adult Americans fall into the coverage gap, because local state government decisions not to expand Medicaid, meaning their income is above current Medicaid eligibility but below the lower limit for Marketplace premium tax credits. These individuals would have been newly eligible for Medicaid had the local state government chosen to expand the Medicaid...
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...Long Term 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 made careers for themselves. Now they are retired and enjoying life traveling and spending time with family. However, now Mary has developed a disease called Alzheimer’s that has left her with a limited memory and sundowner’s syndrome. Her husband Don cared for her initially but is unable to due to health care challenges he is also facing. The couple is also experiencing financial issues as their retirement fund is dwindling down. They are unable to completely pay for their at home care which has led the couple to seek financial help from family members. Don and Mary now need to come up with a plan for their elderly care. Decisions need to be made about the type of care needed, the availability and financial options. The first decision that needs to be made is the type of care that is needed for both of their conditions. Don has physical needs that leave him unable to care for himself. Mary has Alzheimer’s disease that requires around the clock attention. Don and Mary’s...
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...treatment. They are there to guide and work with the NP's to meet the patient’s goals and provide optimum care needed by the patient. Team-Based approach is the current setting of NP and Doctors in California and some other states who doesn't allow NP to practice independently. Having a common goal for the patient’s outcome and to maintain the individuals health gives both NP and MD advantage to care for the patient. It allows the NP to practice with the physician and to render health care services that are within the scope of the practitioner’s expertise. The setup of a provider’s office always depends to the state law. And also, Medicare and other insurances always defer to the state law requirements upon billing. The Definition of Incident to Billing Having all that said, Centers for Medicare and Medicaid Services (CMS), have provisions using "Incident to Billing" saying that Physicians can bill for the services provided by the NPs and staff who are in the same practice and working together as long as they are within an institution (CMS 2013). Thus, it also requires that the MD should provide the initial service or treatment and would supervise or get involve in the...
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...Medicare and You DeLee Glasser Western Governors University Medicare and You As we age, medical care is often needed. Medicare is government provided health insurance, available to those who are at least 65 years of age, and for those who are younger with certain disabilities. There are many different parts to Medicare, some requiring out of pocket expenses, and/or deductibles. Medicare Part A The rules for Medicare are often complex, requiring the nursing and/or social work staff to get involved, and help navigate the system. The hospitalization portion of Medicare is “Part A,” which will cover the acute care hospitalization, and the skilled nursing facility (SNF) portion, of Mrs. Zwick’s illness. If, at a later time, Mrs. Zwick was in need of home health care, and/or hospice care, Part A would also be responsible for the coverage of these services. Services, not covered, would be any long-term custodial or unskilled nursing care. After meeting the insurance deductible, Part A is usually a premium-free service, assuming the spouse, or patient, has paid into the system, while employed. As of 2013, the monthly cost for Part A is $441, for those who are not eligible for a premium-free policy. Mrs. Zwick, a permanent United States resident, who has been hospitalized for five days following a stroke, will require further care from a SNF, once she is discharged from the hospital. The deductible for her hospital stay, assuming that she has a premium-free policy, would...
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...Case Law Search There are many cases that address the current critical regulatory issues in health care. Medicare fraud and abuse violations are only but one critical regulatory issue that is happening in America today. Medicare fraud and abuse is a major issue and it must be addressed. Many people today are lying on their applications in order to be approved for Medicare. This is hurting the people who truly need Medicare. Nature of Medicare fraud and abuse laws Medicare fraud and abuse is when someone will make false statements about themselves or that someone else is giving false information so the other person can get Medicare. When Medicare fraud happens it can either be a one person act or from a group of people or even an organization. Many people around commit fraud, in fact you may know someone who has already done so or may do so. “Organized crime is infiltrating the Medicare Program and masquerading as Medicare providers and suppliers” (Department of Health and Human Services, 2012). Some forms of Medicare fraud are: When someone is billing for services but there were no supplies that were available or services, when someone has billed Medicare for appointments that weren’t made, when someone changes claim forms or makes changes to receipts in order to get higher payments. Medicare abuse is when there is unnecessary cost in Medicare. “Abuse includes any practice that is not consistent with the goals of providing patients with services that are...
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...org, 2015). For example, one criteria to receive federal grants and loans from the Hill-Burton fund is that states were required to license entities to ensure that hospital facilities adhered to a set of minimum quality and service requirements. By setting these standards for licensing, healthcare started its journey towards improving and standardizing the health and safety of individuals receiving services. Medicare, a federal health insurance program that pays for many types of health care expenses, is an entitlement program in which U.S. citizens earn the right to enroll by working and paying their taxes for a minimum required time period. Enacted in 1965, Congress decided that minimum standards for this program would be set at the national level but that they would be certified as meeting these standards, by individual state agencies. The Secretary of the Department of Health and Human Services (DHHS), under Medicare Law, established these national minimum standards, also known as the Conditions of Participation (CoPs), for healthcare facilities and other Medicare beneficiaries...
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...Regulatory Agency Paper University of Phoenix HCS 430 Legal Issues in Healthcare: Regulation and Compliance June 8, 2008 The Department of Health and Human Services (DHHS) is one of the many agencies that handle an array of healthcare departments as well as research. The DHHS caters to citizens of all nationalities, race, and ethnicities. The DHHS focus is to protect the health of all Americans and providing the highest level of human services, especially for those who are least able to help themselves. The Public Health Service is divided into 42 subdivisions (Department of Health and Human Services, 2007). This paper will give highlights of the history of the DHHS, the source and scope of authority, how the day-to-day operations are guided and performed, and how DHHS is structured. In addition, examples are given as to the duties that are carried out within the department of the DHHS. History of the Agency The Department of Health and Human Services (DHHS) was established in 1953 and was referred to as the Department of Health, Education and Welfare. In 1979, the agency was recreated and renamed as the Department of Education. The DHHS agency has many components within the agency that handles and maintains day-to-day operations. (U.S. Department of Health and Human Services, 2008). Source and scope of authority According to the statement Office of Inspector General (OIG), the text reads that OIG will ensure that disseminated information meets...
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...Medicare Solvency: The Medicare Trust Fund Leanne Terry HCM 500: The U.S. Healthcare System Colorado State University – Global Campus Dr. Michelle Rose September 13, 2015 Medicare Solvency: The Medicare Trust Fund Medicare is a government funded program within the United States that provides health insurance to individuals who are sixty five years and older, regardless of income or medical history, those that have end-stage renal disease, and/or individuals who are under sixty five years old and have disabilities for which they are entitled to Social Security benefits. The Center for Medicare and Medicaid Services (2015), which operates both Medicare and Medicaid, states that Medicare provides coverage for over 55 million beneficiaries. With the aging of the general population, the number of beneficiaries will continue to rise. Part A of Medicare, also known as the Hospital Insurance (HI) covers hospital inpatient services along with inpatient services at psychiatric hospitals, rehabilitation facilities, hospice care, home health visits, and skilled nursing facility services. “Medicare part B, the supplementary medical insurance (SMI) portion, is a voluntary program financed partly by general tax revenues and partly by required premium contributions” (Shi & Singh, 2015). Another type of supplemental insurance plan that Medicare beneficiaries can purchase is Medigap, a private insurance that has high out-of-pocket costs to cover Medicare deductibles and copayments...
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...------------------------------------------------- medicare trust fund January 17, 2016 Charles gunter January 17, 2016 Charles gunter In 1965, United States instituted the most influential health program in our history. The Medicare and Medicaid program ensured that the aged, disabled, and poor had access to healthcare. The importance of a healthy society had finally made it to the mainstream and become a part of public policy. In this presentation, we will discuss the Medicare program. The Social Security Administration hosts the program and the “Centers for Medicare & Medicaid Services (CMS), a branch of the Department of Health and Human Services (HHS), is the federal agency that runs the Medicare Program” (Centers for Medicare & Medicaid Services, 2015). To enable these programs to work, funds must be allotted for services. The Medicare Trust Fund is one such vehicle. Currently, although suffering a few hits over the years, the Medicare Trust Fund has expanded and contracted through healthy and unhealthy periods (mostly healthy). Fortunately for the rapidly expanding American elderly population, the current state of the fund is promising. The fund has historically faced challenges and may continue to do so, but policymakers are faced with such a large aging (and voting!) population that the health of Medicare will always be top priority. Many factors that create challenge include fund solvency, fraud, and the growth of the population who fall within Medicare eligibility. Here...
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...of your events. Include the following in your timeline: Medicare and Medicaid HIPAA of 1996 State Children’s Health Insurance Program (SCHIP) Prospective Payment System (PPS) 1955 | In 1955 the then Indian Health Services took a new shape as it was taken away from Department of Interior. It was handed over to H.H.S. I learned from ihs.gov that in the past tribal Indians had to submit their land to get health services from US government. The Indian population could get healthy services and this is how their mortality rate decreased. When the services were reassigned to H.H.S. the Indians got more rights to get health services. | 1965 | Medicare and Medicaid came into being on July 30, 1965 as the Social Security Act got revised by the then President L. B. Johnson. The new healthcare programs are federal in type and are mainly for people of 65 and above. People below 65 may be covered if they have some particular disabilities. With these programs people with low or no income get care and | 1971 | The National Cancer Act Law was enacted by President R. Nixon. This law came as governmental war to overcome cancer. If our government paid no attention to this issue, scientists and doctors could not continue their research to provide us with lot of cancer survivors. It is true some people have lost the battle against cancer but we also have many victors in this field. The fight is going on. | 1983 | Medicare Prospective Payment System (PPS) came into existence in October...
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...Medicare Fraud: The History, Incidence, Costs and Institutional Remedies INTRODUCTION In 1965, President Lyndon B. Johnson signed the Medicare Act into law. The purpose was to provide healthcare to individuals the age of 65 or older or individuals under the age of 65 diagnosed with specific medical conditions (Center for Medicare and Medicaid Services, 2013). The original intent was to provide immediate payment to those providing medical services for the less fortunate. The Medicare Act has since been revised to meet the current needs of the American population as well as the United States economy. In part, these revisions included identifying, combating, establishing punishment (criminal laws) and prevention for Medicare Fraud. This paper will provide a brief overview of the Medicare fraud history, incidence, costs and institutional remedies. MEDICARE FRAUD: HISTORY AND DEFINITION Fraudulent activities against the government were first addressed during the Civil War. The False Claims Act (qui tam statute), also known as the Lincoln Act, was passed during this time frame. The intent was to prevent the Union Army from being a victim of supplier fraud. Citizens were given, “the ability to file suits on behalf of the US government whenever they spotted fraud” (Medicare Fraud Center, 2015). The citizens were rewarded with a portion of the monetary fines (issued to the defendant) for addressing the crime. Currently, similar rewards remain in effect for reporting Medicare...
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