HI215: Reimbursement Methodologies
Discussion Topic: The Patient Protection and Affordable Care Act
INSTRUCTIONS: Respond to all posts; response to classmates should be thoughtful and advance the discussion, response should make and/or frequent informed references to unit material or scientific literature, follow APA style if resources are used, 75 word minimum in response per post
CLASSMATE POST #1
The Patient Protection and Affordable Care Act was established in 2010. This legislation contains 10 different titles. For this week’s discussion I will be reviewing titles IV, V and IX.
Title IV: Prevention of Chronic Disease and Improving Public Health – This title focuses on funding and commitment to the prevention, wellness, and public health of the American citizen. The PPACA helps to develop a national health promotion and disease prevention model for obtain and initiate improvements to the overall health of citizens. In addition, the PPACA will also address areas such as family nutrition and implement tools to help families better incorporate that into their daily lives. Making noninvasive procedures and screenings accessible to Medicare beneficiaries without having to pay a copayment for services rendered.
Title V: Health Care Workforce – This title addresses how to increase primary care physicians, nurses, physician assistants, mental health providers and dentists in areas of the country that need them the most. The PPACA creates incentives such as scholarships and loan repayment programs to encourage those wanting to join the healthcare workforce to do so. The PPACA also works alongside each state individually to generate flexibility and resources geared toward recruitment strategies to increase the healthcare workforce.
Title IX: Revenue Provisions – This title focuses on offsetting the premiums for healthcare coverage to the middle-class families and small business by giving them tax cuts that allow for more affordable healthcare insurance. This will allow tens of millions of families to be able to purchase health coverage at a by reducing the premium costs.
I think each title in the PPACA has benefits for many American citizens. This Act was established to provide Americans with access to health care that is both affordable but of quality as well. Changes both to the administrative or operational roles in health care are both impacted by this Act.
~Erin Mackey
CLASSMATE POST #2
The Affordable Care Act, or ACA, aims to provide more subsidies and further coverage to low-income Americans who may not have had healthcare coverage beforehand (Patient Protection and Affordable Care Act, 2021). The ACA contains 10 titles, three of which are: Title IV (Prevention of Chronic Disease and Improving Public Health), Title V (Health Care Workforce), and Title VII (Improving Access to Innovative Medical Therapies). Title IV of the Affordable Care Act deals with the “Prevention of Chronic Disease and Improving Public Health” by working with state agencies across the map to provide free access to preventative care (Affordable Care Act Provisions, 2021). Through the team efforts of Medicaid and CHIP, public awareness campaigns are specifically designed to educate Medicaid patients on preventative care and obesity services, striving to encourage a healthier America.
Title V deals with the “Health Care Workforce” which is self-explanatory in its title, as it deals with expanding the healthcare workforce by attempting to fix the nursing shortage (Title V. Health Care Workforce, 2021). This title deals with providing ample educational opportunities, scholarships, loan repayment, incentives, recruitment strategies, and retention efforts to encourage the growth of America’s healthcare professionals. Lastly, Title VII deals with “Improving Access to Innovative Medical Therapies” which seeks to offer more drug discounts to hospitals and the low-income. It strives to combat the greedy drug companies’ efforts to make affordable, generic prescription drugs less attainable and accessible (Title VII. Improving Access to Innovative Medical Therapies, 2021). It encourages the creation of more generic drugs by creating avenues to do so, benefitting both providers and patients.
These titles encourage the flow of the revenue cycle and reimbursement to providers. Since the ACA has helped more Americans attain health insurance, this generates more patients being seen across all facilities. As an Advanced MD article (2016) explains, the ACA has eliminated pre-existing conditions exclusions, further creating more patients. It provides more care to pregnant women as well as mental health services for substance use, as payers are required to cover more for these services (How the Affordable Care Act Will Affect Provider Reimbursement, 2016). The healthcare industry and healthcare reform are forever changing. These systems are always growing, revolutionizing American healthcare and the revenue cycle across the board.
~Jenna Collins~
HI230: Quality Assurance and Statistics in Health Information
Discussion Topic: Roles
INSTRUCTIONS: Respond to all posts; response to classmates should be thoughtful and advance the discussion, response should make and/or frequent informed references to unit material or scientific literature, follow APA style if resources are used, 75 word minimum in response per post
CLASSMATE POST #3
According to Oachs & Watters, case managers are responsible for ensuring patients receive sufficient care in all aspects. This includes evaluating that hospital admissions are following the predesigned process, case managers being assigned to specific patients during their stay in the hospital, they remain with the patient during their stay to ensure they are getting appropriate care for their medical and psychosocial needs, and they follow up on any ongoing needs following the patient’s discharge from the hospital. (2020)
According to Oachs & Watters, the American Case Management Association (ACMA) considers a few of the responsibilities of a case manager to be ensuring the best care possible is being provided to each patient, that the patient has access to the care they require, that medical practice resources are being appropriately utilized, and that these are all balanced with the patient’s right to self-determination. (2020)
To answer the question of what roles should be fulfilled by case managers to ensure appropriate coordination of resources, I would say they have many responsibilities to patients and ensuring patient care, but they also need to balance the resources of the practice and ensure that they are being utilized appropriately. They need to have the role of administrator to oversee that these resources are following the design set up by the practice board of directors.
The case manager role provides a way for information to be passed between different departments within a medical facility to ensure all of the patients’ needs are being met. This allows for collaboration between departments to take care of the patients and ensure all of their medical needs are being met. Case managers play a key role. In my experience with hospitals, each patient is assigned a social worker or case manager when they are admitted to the hospital that comes in and does a review of their needs then coordinates with medical providers, physical therapy, occupational therapy, the insurance company, and any other necessary departments to ensure all of the needs of the patient are being met and when they get released from the hospital they will have all of the necessary resources to improve their health.
~Moriah Conley~
CLASSMATE POST #4
Case managers “review the condition of patients to identify each patient’s care needs and to integrate patient data with the patient’s course of treatment” (Shaw & Carter, 2019, p. 139). The case manager is responsible for mapping a patient’s care and treatment plan based on their condition so there is a positive outcome. A case manager should follow steps that are outlined by the Utilization Review Accreditation Committee [URAC].
Step 1: Perform Preadmission Care Planning
Step 2: Perform Care Planning at the Time of Admission
Step 3: Review the Progress of Care
Step 4: Conduct Discharge Planning
Step 5: Conclude Postdischarge Planning
(Shaw & Carter, 2019, p. 141)
These steps are standards for an organization that promotes the quality and accountability of healthcare. This communication is key to the continuum of care success. When these roles are established and efficient they are very effective in the level of care a patient is provided. Being able to provide a continuum of care is vital to an organization’s ability to provide quality healthcare services.
~Cheryl Stanley~
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