...Medicare is a national government-sponsored health insurance program in the United States of America. On July 30, 1965, President Lyndon B. Johnson signed Medicare into law in Independence, Missouri. Medicare offers health insurance for Americans aged 65 and older. It also provides health insurance to younger people with disabilities, end-stage renal disease, and ALS. Medicare is the primary insurer for 54 million Americans. Medicare is a single-payer health care program, covering all eligible beneficiaries under a single, publicly financed insurance plan. Government spending on Medicare in 2013 was $583 billion, or 14 percent of the federal budget (Centers for Medicare and Medicaid Services, 2014). Hospitals, healthcare providers, and suppliers participating in the Medicare program must meet minimum health and safety standards. The standards are defined in the Code of Federal Regulations, Title 42. The Centers for Medicare & Medicaid Services (CMS) defines Conditions of Participation (CoPs) and Conditions for Coverage (CfCs) that set the standards that health care organizations must meet to begin, and continue participating in Medicare. CMS currently has approved seven accrediting organizations that can accredit a heath care organization as having “deemed status”. The national accrediting organization surveys a health care organization and certifies that they satisfy the health and safety standards component of the Medicare certification (Centers for Medicare & Medicaid Services...
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...the incorporation of health informatics to justify apparent flaws in the government programs such as Medicaid, TRICARE and Federal Employees Health Benefits Program are three legislative policies which impede its progress. With most disciplines there exists certain parameters which provide the basic focus for which the disciplines fashion themselves around. In all there are seven elements in the public health sector; http://www.cdc.gov/mmwr/preview/mmwrhtml/su6103a5.htm, and in this scope exist, planning and systems design, data collection, data management and collation analysis, interpretation, dissemination, and finally the application to public health programs. Like most new technologies; robust changes to processes can be delivered, but are met with opposition. Health information technology can defeat a lot of the lethargic processes comprised in healthcare management, but arguably by some as the use of terms such as unintended consequences can slow growth to the field and prospects of health information exchange http://www.amia.org/amia2012/panels. It is believed that while the Electronic Health Record would be composed and stored within secured database systems that there is huge risk which exist; patient privacy, as mandated by the Health Insurance and Portability and Accountability Act (HIPPA). The opposition that some have towards health informatics are that we do not know how to regulate the content and the management of the same. Impediments include laws and...
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...the incorporation of health informatics to justify apparent flaws in the government programs such as Medicaid, TRICARE and Federal Employees Health Benefits Program are three legislative policies which impede its progress. With most disciplines there exists certain parameters which provide the basic focus for which the disciplines fashion themselves around. In all there are seven elements in the public health sector; http://www.cdc.gov/mmwr/preview/mmwrhtml/su6103a5.htm, and in this scope exist, planning and systems design, data collection, data management and collation analysis, interpretation, dissemination, and finally the application to public health programs. Like most new technologies; robust changes to processes can be delivered, but are met with opposition. Health information technology can defeat a lot of the lethargic processes comprised in healthcare management, but arguably by some as the use of terms such as unintended consequences can slow growth to the field and prospects of health information exchange http://www.amia.org/amia2012/panels. It is believed that while the Electronic Health Record would be composed and stored within secured database systems that there is huge risk which exist; patient privacy, as mandated by the Health Insurance and Portability and Accountability Act (HIPPA). The opposition that some have towards health informatics are that we do not know how to regulate the content and the management of the same. Impediments include laws and...
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...Healthcare Technology Lisa Schirmeister HCS/212 Abstract Healthcare technology is always changing over the years. It is used in a wide range of area, from how diagnosis are made, treating different types of disease, and management of medical/health records. Technology has been used to asset in the different fields of healthcare. Studies are done to find ways to improve the way we take care and manage personal confidential information of our patients. Healthcare Technology As of 2011, per Center for Medicare and Medicaid Services all hospitals, doctor office and clinics shall convert from the standard paper records over to electronic records by 2014 to receive any incentive pay. Making electronic medical records and/or electronic health records one of the fastest growing medical technologies in the United States. Electronic Medical Records (EMR) vs Electronic Health Records (EHR) Both electronic medical record (EMR) and electronic health records (EHR) both are a computer bases documentation of your medical and health records. They are very similar to each other. They are the same of as paper medical charts, which contain information from test, labs, medications and doctor notes. EMR is mostly used for treatment and is not easily transmitted to other providers outside of the primary offices. EHR goes further and includes a more complete outlook to the overall patient history. EHR will allow patients to move their health record from one doctor to another. The use...
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...The whistleblower (or “qui tam”) supplies of the False Claims Act let private people to bring suit on behalf of the government against persons or business who have present fake assert to the government. Under the Act, a whistleblower is free to a percentage of the costs that the government finally get thus of the court case. The qui tam supplies have been used with increasing occurrence in current years to start court case against pharmaceutical producer for deception that these companies have supposedly committed against federal and state health care programs. This paper tries to clarify the effects that these whistleblower court case have had upon the health care industries. This paper also suggests traditions that the False Claims Act and government enforcement efforts could be rehabilitated in order to decrease both playful qui tam court case and require for such wide False Claims Act trial History of the Whistleblower Provisions of the False claims act The False Claims Act (“FCA”) is one of the strongest tackle the government possesses for fighting fraud adjacent to the United States. As the government may bring suit to improve sufferers from deception without collaboration from private people, the FCA also approve private people with non-civic information relating to the deception to bring suit on behalf of the government. These whistleblower (or “qui tam”) suits allow the applicant to get a proportion of the revival for the government, that...
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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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...University Healthcare Ecosystems Influence of Federal Government Programs And Accreditation standards Medicare is a federal government insurance program in United States, Created by Congress in 1965, under president Lyndon B. Johnson, and implemented on July 1st, 1966. The purpose of Medicare is to guarantee access to health insurance for US citizens of age 65 and over and to people of any age with disabilities. According to Centers for Medicare & Medicaid Services (CMS), approximately 19 million Americans were enrolled in the Medicare program in 1966. In 2008, approximately 45 million people were enrolled in Parts A or B (or both) of the Medicare program. By February 2012, 12.8 million of the enrollees participated in a Medicare Advantage plan. It was the primary payer for an estimated 15.3 million inpatient stays in 2011, representing 47.2 percent ($182.7 billion) of total aggregate inpatient hospital costs in the United States (Torio & Andrews, 2013). The program helps with the cost of health care, but it doesn’t cover all medical expenses or the cost of most long-term care A portion of the payroll taxes paid by workers and their employers cover most Medicare expenses. Monthly premiums, usually deducted from Social Security checks also cover a portion of the costs. Medicare’s Impact on Today’s Healthcare Ecosystem Medicare has four parts • Hospital insurance (Part A) helps pay for inpatient care in a hospital or skilled nursing facility (following...
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...SCHOOL OF PUBLIC HEALTH Cover sheet for Assignment 1 Student Surname__Ullman_________ Student First Name___Kiri_______________ Student Number _____16156957__________________________________________ Unit Name _____Healthcare Systems in Australia_______________________________ Assignment ____SWOT Analysis and Report__________________________________ Unit Coordinator__Caroline Yates__________________________________________ Date Due __10/04/2015____________________________________________________ 10/04/2015 10/04/2015 Date Submitted → I, Kiri Ullman, certify that this is all my own work, and that I have maintained academic integrity. I maintain there has been no colluding or plagiarism in this assignment. Signed Kiri Ullman 16156957 Contents 1.0 Introduction____________________________________________________________2 2.0 Strengths 2.0.1 Medicare__________________________________________________________2 2.0.2 Eligibility and Coverage of Medicare___________________________________3 3.0 Weaknesses 3.0.1 Indigenous Health__________________________________________________3 3.0.2 Availability________________________________________________________4 3.0.3 Limitations of Medicare______________________________________________4 4.0 Opportunities 4.0.1 E-health Records and Technology_____________________________________4 4.0.2 Ambulance Fees____________________________________________________5 5.0...
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...Dealing with Fraud By: Kevin McCarthy To: Dr. Michelle Rose HSA 515 Health Care Policy, Law, and Ethics December 13, 2012 Abstract As the Chief Nursing Officer, I am responsible for one of the state’s largest Obstetric Health Care Centers. I have received word of some fraudulent behaviors in the center. I will evaluate how the Healthcare Qui Tam affects health care organizations. I will provide four (4) examples of Qui Tam cases that exist in a variety of health care organizations. I will devise a procedure for admission into a health care facility that upholds the law about the required number of Medicare and Medicaid referrals. I will recommend a corporate integrity program that will mitigate incidents of fraud and assess how the recommendation will impact issues of reproduction and birth. I will devise a plan to protect patient information that complies with all necessary laws. Evaluate how the Healthcare Qui Tam affects health care organizations Qui tam is shorthand for a Latin phrase that means “he who sues for the king as well as for himself.” In a qui tam case, the whistle – blower (aka relator) files the suit as a kind of “private attorney general” on behalf of the government. The government can choose to take over the prosecution, but if it declines to do so the relator can proceed alone (Showalter). Any person with information about health care fraud can be a qui tam plaintiff. Person is defined as “any natural person, partnership, corporation, association...
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...Clinical Information Technology versus Financial Information Technology, and the definitions of health care information, and health care acronyms and remittance terms Jesse Davis Jr. University of Phoenix MBA 533/ Health Information Systems December, 2014 Professor Aimee Kirkendol Health information related acronyms, their translation, and elucidation The field of healthcare is primarily concerned with the care of people requiring preventive and medical care. However healthcare is a business. The business of health care generates trillions of dollars for the national and international health care communities. Health care as a right in the United States precludes the fact that capitalism rules every aspect of citizen life, especially health care. The factors primarily affecting health care include new technologies. The medical technology industry is a 150 to 200 billion industry. Prescription drugs, government regulation, malpractice liability and the aging of the largest generation birthed in the U.S., the Baby Boomers (78 million). Every day in the U.S., 10,000 Baby Boomers reach age 60, putting greater demands on medical services. Chronic diseases, many preventable (diabetes, cancers of the lung and cardio vascular disorders) also contribute...
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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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...This paper will explain how the past health care has change and the dynamics behind the changes in the health care industry today. Also in this paper the importance of financing and technology in the health care. The discussion of the complexities that is associated with changing demographics and emergent diseases, and the fluctuating and daunting challenges that management mortality trends that the Baby Boomers generation predicate. Summarize the key milestones involved in the past and present shaping and transitional dynamics behind changes in the present healthcare industry. 1850-1900 was a time were the environment condition such as water sewage disposal, contaminated food, inadequate housing were the cause of illness of infectious disease in the United States. People had to rely on home remedies, or woman who took care of the ill and no medical care was available. Doctors had little training in the scientific technology field and hospital was dirty run down which bought about a threat to life because of the diseases. Public health problems came about with such epidemics of acute infectious diseases. Before World War II military families and officers could get free of charge medical care. The federal government was not involved, they left it up to the states and the states had little to do with it. They left it up to private and programs that were voluntary. By 1930s hospitals were giving services to individuals on a pre-paid basis which, allowed for members to...
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...National Health Reform - Decreased Cost in Medicare and Medicaid: How Does it Impacts Nursing Home Care in New York State by Vina Aileen Bonner HCA 621 Utica College Fixing medical care and health insurance in the United States has been a public policy concern for about a century. Presidents such as Theodore Roosevelt, Harry S. Truman, John F. Kennedy, Richard Nixon, Jimmy Carter and Bill Clinton focused on the National Health Reform, but only President Barack Obama achieved the health care reform. Health care costs are increasing while the access to health care is declining. The occupationally based health insurance system is greatly stressed. Medicare and Medicaid are consuming more of the federal budget. According to the White House’s budget for U.S. Department of Health and Human Services (HHS), President Obama’s proposal would save nearly $360 billion in Medicare and Medicaid over the next 10 years: $56 billion would come through Medicaid reforms. Medicare is a federal health insurance program providing health care benefits to all Americans age 65 and over. Medicare is a significant part of the reason the national debt is soaring out of control. It is an open-ended program for provided for millions of senior citizens and people with disabilities. Medicare is growing faster than Social Security and more expensive in the next 25 years. Nationally, health care experts believe that as much as third of all health care spending – about $800 billion in...
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...In today’s health care environment patient safety has become one of the most important objectives in all health care institutions. One of the main issues when it comes to safety of patients is errors that can occur when abbreviations are not used properly when dealing with health information technology. It is important for health care employees to have knowledge and a clear understanding of what the abbreviations stand for, as well as the purpose of them. When dealing with a patient’s personal information that concerns their medical history, there must be the use of accurate written or computerized documentation at all times. This paper will define the following abbreviations: AMR, CMR, CMS, CMS 1500, CPT, DRG, EPR, HL7, ICD-9, UB-2, and the important role each plays in health care information technology. AMR The abbreviation AMR refers to what is known as Automated Medical Records. An Automated Medical Records system is used to record all information concerning a patient’s care from the initial consultation, the admission into the hospital if applicable, any treatment involved and medications dispensed, to the final billing (Pinkerton, 2006).When an AMR is used the amount of paperwork associated with a health care practice or hospital can be lessened. Automated patient information has the capability to provide health care workers and organization with patient information that can be critical when treating them. The information that is put in the system can be easily accessed...
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...From: Alisha Clarke, Chief of Staff Date: 9/9/2012 Re: Medicare Funding Crisis Congressman Hughes, Below, please find the prepared document for the panel discussion. Introduction As you all may know, Medicare is currently the object of scrutiny in regards to its funding and how it is effecting the current healthcare situation. There are many perspectives in which to look at this program to decide whether or not it is actually a positive attempt at resolving current healthcare issues. First and foremost, I believe that our society is misinformed about the current status of the Medicare program. So I will take time out to address key questions in regards to the program. Is Medicare in a state of crisis? Are radical measures necessary to preserve the program? Medicare is so definitely in a state of crisis as we speak. “particularly for Medicare, which is so far underwater it would take several United States’ to pay off just what is owed right now to those who have already paid into the system (and who are therefore owed benefits at some point).” (Emanuel, 2012) It seems that the detrimental effects of the Medicare system will indeed have the most impact on the current senior citizen population, baby boomers, and the military. The reason for this is because the accessibility to physicians seems to be decreasing which could definitely hurt these populations. Physicians who currently participate in the Medicare program are enduring payment cuts which might have them...
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