Medicare: Inpatient Prospective Payment System

Technology is used in the health care system to chart patient health information, communicate with the interprofessional team, and monitor plan of care. The nurse, upon licensure, recognizes the importance of computer literacy and the effect technology has on patient outcomes. The use of technology can hinder or help the patient based on its use. For this reason,

Medicare reimbursement is partially based on a facility’s Star Rating. A critical component to this is patient surveys and HCAHPS. I have seen a push toward the customer service experience. Indeed, I feel strongly that every healthcare worker including nurses should treat each of their patients with respect, equality and do the absolute best to meet their needs.

In this assignment I have found quotes for different insurance plans, by using my personal information that I have entered into the database. The website I have chosen to use for this assignment is https://www.healthcare.gov/apply-and-enroll/health-insurance-plans-estimator-overview/ and based on the information I put in the computer, the two health insurance company quotes that were offered to me were many forms of Blue Cross Blue Shield Healthcare plan of Georgia and Kaiser Permanente in some categories of bronze, silver, gold, and others. Some of the plans that was specifically offered to me were, Blue Cross Catastrophic Pathway HMO 7150, Kaiser Permanente Catastrophic 7150, Kaiser Permanente Bronze 6200, Blue Cross Bronze Pathway HMO 5850,

Depending on which approach is being used the cost for bed/day, medical treatment and nursing care can be higher and lower. With this new

Hence, medical practices are advised to do a cost-benefit analysis to determine if hiring more personnel will indeed prove helpful, or it is better to accept longer reimbursement cycles. Now think about the accuracy. It is not possible for coders to know if the assigned ICD-10 codes are proper, given their inexperience with the new code set. Also, there is little room for feedback since October 1 is right around the corner.

The activities and formation of ACOs that do not fall within the "antitrust safety zone" will generally be evaluated by the Agencies under the Rule of Reason, which weighs the potential anticompetitive effects of collaboration against its potential pro-competitive effects, such as enhancing efficiency. The Policy Statement notes that the Rule of Reason will be applied by the Agencies "if providers are financially or clinically integrated and the agreement is reasonably necessary to accomplish the pro-competitive benefits of the integration." Converting from fee-for-service (FFS) model to value based reimbursement has brought many challenges to healthcare providers. These challenges include shift in payor mix, shared savings and increase in tracking provider quality and performance. The shift in payor mix relates to the decrease in commercial patients with higher reimbursement rates while Medicare and Medicaid patients with lower reimbursement rates will increase.

improving quality of American health care system and curbing the care costs, at the moment numerous ways of restructuring care supply are being evaluated by CMS. Accompanying Medicare shared savings program, initiatives like Advanced Payment Incentive and Pioneer ACO demonstrations are being commenced. Other global health service organizations such as Cigna, Aetna and Anthem are also supporting this health reform model and endeavoring to improve health service system by acquiring health service providers to raise the level and quality of care supply. As well as this kind of health insurance companies provide other incentives to healthily systematized care provider

The HIM quality coordinator should include the HIM director and staff member in this process, and also make an attempt to secure upper management buy-in for the proposed solution. The HIM coordinator should seek collaboration across all departments in an attempt to address these issues, and develop an effective workflow process within the HIM department to ensure bill hold is held below $500,000.00 mark. Next step of action will involve having all physicians onboard with the new workflow process, which means that physicians make every effort to complete their patient’s file within a reasonable timeframe, and having a physician champion can help smooth things out. Lastly, there will be need to establish an effective policy to reduce the length of billing hold; this policy will specify a three to four day holding period, and with the support from upper management the organization can levy a penalty against any clinician/physician that fail to complete their patient’s file in a timely

The favorable variances exhibited on the same table are the insurance payment revenues (550), donations revenues (50), and clerical/technical expenses (200). On the other hand, the unfavorable variances are the managerial/professional expenses (-750), benefits expenses (-200), supplies and materials expenses (-100), and travel expenses (-150). Additional information should be collected and analyzed in order to explain the positive and negative variances. These factors include the monthly patient census, patient acuity, staff turnover rates, staff meetings and orientation, paid time off utilization, and mandatory staff training and workshops (Yoder-Wise, 2011). Different

California Medicaid program, also known as Medi-Cal is the largest Medicaid program in the nation. With the rollout of Medicaid expansion in 2014, the Medi-Cal is suffering an unsustainable high ED use rate. The identification of a model of care to direct patients to the appropriate setting for care has emerged as a top priority for the state’s health policy.

According to Patterson & Krouse (2015), It is important to transfer the message in a good way, for that the communication skills is one of the most important basic skills of nursing leadership. More than that, communication in nursing can make their job efficiently and help them to communicate with a wide range of people, including the patient, patient 's family, and healthcare providers. However, unlike bad communication, which increases nursing staff problem and can lead to worsening the patient health condition, a good communication saves time and reduces the problem of nursing staff in resaving and deliver the right information. Furthermore, communication is not only talking with the patient it’s also listening to what the patient 's family and healthcare providers are saying to collect more information that helps the nurses to save lives. In this paper, I will reflect my communication that goes well with one patient.

Nurse Bedside Shift Report Implementation Handbook Submitted by Manju Bhattacharya Table of Contents Introduction --------------------------------------------------------------------------------------------------------------------1 Overview of the Nurses Bedside shift Report strategy ----------------------------------------------------------------1 - What is the Nurse bedside shift Report tool? ---------- -------------------------------------------------------------------2

This is because the effective communication through patient-centred care allows patients and healthcare professionals to form a therapeutic relationship resulting in better health outcomes. Moreover, patient safety is ensured when members of the healthcare team communicate effectively as this ensures quality and continuity of care. Effective communication also impacts the accuracy of documentation which is an essential component of patient safety. With the influence of communication on patient safety, further research such as longitudinal studies as well as experimental studies must be conducted to establish these findings. Furthermore, the government could take further steps to decrease the adverse effects of ineffective communication while increasing the benefits of effective communication through the implementation of rigorous standards in regards to the communication skills of healthcare

Great post and Thank you for sharing your AACN Self-Assessment score. I totally agreed with you “Nurses must be active participants in the design of automated documentation to ensure that information is recorded appropriately and in a format that can be accessed and useful to all healthcare providers” (Hebda & Czar 2013). Nursing has evolved into a world of electronic records. It is no longer only important that your nursing skills be excellent, but your ability to use a computer to document, give medicines, send specimens, check patients’ status, submit orders, and access data. “The tools and technology that nurses need to perform their work efficiently are changing in such a way that informatics competencies play a greater role” (Hebda &

Nurses play an essential role in the healthcare industry. The nurse workforce is made up of licensed nurses: registered nurses (RNs), licensed vocational nurses (LVNs) and licensed practical nurses (LPNs), along with nurse aides. Registered nurses are responsible for assessments of patients’ needs, development of care plans, medication administration, and treatments, while licensed vocational nurses perform specific care under the delegation of the registered nurses and supervisions. Nursing aides perform activities of daily living (unskilled attention) to the patient. Adequate nursing staffing is essential to both patient care and outcomes, also to the retention of nurses while inadequate staffing creates problems for both the patients and