Under the Balanced Budget Act (BBA), the Health Care Financing Administration (HCFA) put into effect a nationwide Prospective Payment System (PPS) within Skilled Nursing Facilities to reimburse inpatient service costs for beneficiaries covered under Medicare Part A as of July 1,1998 (Skilled Nursing facility PPS, 2013). Generally, Medicare Part A covers beneficiaries within the following inpatient settings: SNFs, hospitals, nursing homes, hospice, and home health services (What Part A Covers, n.d.). Medicare Part A uses a Prospective Payment System at a per diem rate. In other words, Medicare Part A pays SNFs pre-determined daily rates for patient care, meaning they are dictating the daily allowance of expenses used for services (Skilled Nursing
To further elaborate, the organization was brought up to manage and restore the attention of Medicare, Medicaid, and other related quality services and provide them to the American citizens who dire needed them. This is said in the first paragraph, “The Health Care Financing Administration (HCFA) was created in 1977 to combine under one administration the oversight of the Medicare program, the Federal portion of the Medicaid program, and related quality assurance activities,” (Federal Register. n.d.). The remaining of the article emphasizes the services by defining and explaining what Medicare and Medicaid are, and gives elaborate declarations of the two. Finally, to end by changing the name to Centers for Medicare and Medicaid Services in July, 2001.
The accredited standards committee has been charged with developing the standards for EDI. The department of health and human services embraced the ASC X12 standards. The goal of EDI standards is to make seamless transfers of information between providers and healthcare plans and payers. ASX X12N 837 is a messaging standard that covers the electronic submission of healthcare claims (Sayles, 2013). The Pan American EDIFACT Board (PAEB) directs activities regionally for EDI message development, maintenance, and technical assessment.
The purpose of the HIPAA transactions and code set standards is to simplify the processes and decrease the costs associated with payment for health care services. The transactions and code set standards apply to patient-identifiable health information transmitted electronically. Physician practices will continue to be able to submit paper claims. When the regulations take effect in October 2002, standard formats and code sets will take the place of any payer-specific or location-specific formats or requirements. ICD-9-CM Volume 1 and 2: Diagnosis Coding - ICD-9-CM is used to code and classify morbidity data from the inpatient and outpatient records, physician offices, and most National Center for Health Statistics (NCHS) surveys.
In 1987, the name was shortened and it became the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). This was necessary to provide Medicare and Medicaid to patients because these are government programs and needs to be evaluated to keep funding available for the healthcare
Their plan is set up so that “insurers in all marketplaces must offer a defined set of “essential health benefits” in all plans and may offer plans at four coverage levels: platinum…followed in descending order of cost and coverage benefits by gold, silver, and bronze.”(Scheffler, Para. 7) With this system, California ensures that each of its providers offers equal health insurance plans that provide the same benefits and deductibles for the same price. Having states be in
The HIPAA security rule is series of papers which provides guidance upon medicare and Medicaid Services based on the rule titled “Security Standards for the Protection of Electronic Protected Health Information,” found at 45 CFR Part 160 and Part 164, Subparts A and C, commonly known as the Security Rule. This rule was adopted to implement supplies of the Health Insurance Portability and Accountability Act of 1996. This security series contains seven topics each is related to the HIPAA security rule. In my paper I will discuss about the technical safeguards. These technical safeguards are becoming more important due to many technology advancements in Medicare industry.
The Health Care Affordable Act is a health care reform policy that guarantees all citizens the right to health care. According to the American Nurses Association website, “the American Nurses Association has been advocating for health care reforms that would guarantee access to high-quality health care for all. With the passage of the Patient Protection and Affordable Care Act (PPACA), millions of people have greater protection against losing or being denied health insurance coverage, and better access to primary and preventive services. ANA recognizes the debate of health care is not over, and remains committed to educating the nursing public about how the changing system impacts our lives and our profession” (American Nurses Association, 2016, P.1). The Health Affordable Act has had a major impact on my practice, in relations to, providing holistic care to the community that seeks health care.
The purpose of the program is to ensure better care, healthier people, and smarter spending (CMS). Every program has been created under certain conditions, and Medicaid is not an outlier. When Medicaid was created in 1965, it was done so by President Lyndon B. Johnson by passing an amendment to the Social Security Act called the Medicare amendment with the
(September 30, 2013) - The Department of Health and Human Services (HHS) published amended rules applicable to the Health Insurance Portability and Accountability Act (HIPAA) of 1996 in January 2013. As explained by the Secretary of HHS, healthcare has experienced significant changes since HIPAA was enacted in 1996. The implementation of electronic medical records is just one of those changes. The new HIPAA regulations are designed to provide patients with better privacy protection, and additional rights not included in the original HIPAA rules. The new rules became effective on Sept. 23, 2013.
According to the United States Department of Health and Human Services the Health Insurance Portability and Accountability Act was created in 1996 to protect patient’s information as it is being used to create a higher quality of care for the individual. HIPAAs biggest aspect is the creation and management of electronic medical transactions. When we think of HIPAA we normally think mainly about patient documentation, but HIPAA includes coding. The Medical Coding and Billing Organization tells us that HIPAA’s effect covers to almost every part of the medical billing process, from how records are kept and retrieved to how codes are used in generating claims. Ethics in Medical Coding is the same ethics that cover everything else.
Firstly, the Health Insurance Portability and accountability Act (HIPPAA) of 1996 was made up with five titles. The impact for HIPPA was to ensure coverage of health insurance after leaving an employer. Also, HIPPA provides standards for facilitating heath care related electronic transactions. Secondly, Medicare part D prescription drug benefit subsidizing drug benefits for Medicare beneficiaries was born out the Medicare Modernization act of 2003. President George W. Bush was the one who sign the legislation into law.
CAL. FAM. CODE § 6926 (2012). DIAGNOSIS OR TREATMENT OF INFECTIOUS, CONTAGIOUS, OR COMMUNICABLE DISEASES; CONSENT BY MINOR TO CERTAIN MEDICAL CARE; LIABILITY OF PARENTS OR GUARDIANS (a) A minor who is 12 years of age or older and who may have come into contact with an infectious, contagious, or communicable disease may consent to medical care related to the diagnosis or treatment of the disease, if the disease or condition is one that is required by law or regulation adopted pursuant to law to be reported to the local health officer, or is a related sexually transmitted disease, as may be determined by the State Public Health Officer. (b) A minor who is 12 years of age or older may consent to medical care related to the prevention of a sexually transmitted disease.
The need for standardized quality measures has been evolving as insurances companies, patients and employers want more data driven health outcomes that improve patient health while reducing cost. The National Committee for Quality Assurance and the federal Agency for Health Care Research and Quality (AHRQ) along with CMS have been a leaders in utilizing evidence based methodologies and measuring quality outcomes to improvement health. The Healthcare Effectiveness Data and Information Set (HEDIS) is the most widely set of quality measures in the U.S incorporating quality measures across many domains of treatment identification strategy in the Initiation and Engagement measures, based on procedure, diagnosis codes and chart audits that is feasible