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Health Care 10 Pages

Indian Health Service

Question

1.Medicare (original Medicare only without Medicaid)

2.The Federal Employees Health Benefits Program

3.Indian Health Service

4.TRICARE

Choose one of the Federal Government Payer Programs from the list attached above to write your entire paper on – the same one throughout the paper.  Remember, for this course the real driving issue is “How do healthcare providers and hospitals file claims with Federal Government Payer Programs to receive reimbursement for healthcare services already rendered (not incentive payments), so they can meet overhead and payroll costs, to keep their doors open to continue to provide patients access to healthcare services (not medical records).  Please use original Medicare only as one of the four choices – neither Medicare Advantage nor Medicaid is a federal government payer.

*You will need to consider both healthcare providers and hospitals on each of the prompts for this Task.

 For A. 1. Standards – explain what about the Federal Government Payer Program you have chosen requires healthcare providers and hospitals to be licensed, certified, and accredited.  For Medicare, it will be the Conditions of Participation.  For TRICARE, Indian Health Services, and the Federal Employee Health Benefits Program it will be the Managed Care Contracts

For A.2.a Clinical Quality Reporting Systems - explain what about the Federal Government Payer Program you have chosen requires healthcare providers and hospitals to meet clinical quality standards and record them.  For Medicare this will be the Physician Quality Reporting Standards (PQRS) or the Value Based Purchasing System (VBPS) covered in the CMS website.  There will be entries in the Managed Care Contracts for the other possible Federal Government Payer Programs.

For A.2.b – Reimbursement – still covering the same Federal Government Payer Program discuss the way healthcare providers and hospitals are reimbursed by this program for healthcare services that have already been provided – remember, incentive payments are NOT reimbursements – they will be covered in a later course.

For A.2.c. – Patients’ Access - still covering the same Federal Government Payer Program discuss the way healthcare providers and hospitals continue to provide patients access to healthcare services (not access to medical records – that has nothing to do with the economics of healthcare delivery and will also be covered in a later course.)

For B.1 – Role of Health Informatics Professional – remember that you cannot use the phrase “Health Informatics Professional”!  You must identify a specific health informatics professional role– HIM specialist, coder, reimbursements specialist, Business Office Manager, billing and insurance clerk, etc., etc. and explain how they work with whichever Federal Government Payer Program you have chosen.

You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. 

 Not EvidentApproaching CompetenceCompetent
A1. Impact on StandardsAn explanation is not provided.The explanation does not identify one federal government payer program or does not logically discuss how the chosen federal government payer program impacts licensure, certification, or accreditation standards.The explanation identifies one federal government payer program and logically discusses how the chosen federal government payer program impacts licensure, certification, or accreditation standards.
A2a. Clinical Quality Reporting SystemsAn explanation is not provided.The explanation does not logically discuss how the chosen federal government payer program influences clinical quality reporting systems.The explanation logically discusses how the chosen federal government payer program influences clinical quality reporting systems.
A2b. Reimbursement for Healthcare ServicesAn explanation is not provided.The explanation does not logically discuss how the chosen federal government payer program influences reimbursement for healthcare services.The explanation logically discusses how the chosen federal government payer program influences reimbursement for healthcare services.
A2c. Patient Access To CareAn explanation is not provided.The explanation does not logically discuss how the chosen federal government payer program influences patient access to care.The explanation logically discusses how the chosen federal government payer program influences patient access to care.
B1. Role of Health Information Management ProfessionalsA discussion is not provided.The discussion does not include relevant responsibilities of a health information management role or does not logically address the effect of the chosen federal government payer program onThe discussion includes relevant responsibilities of a health information management role and logically addresses the effect of the chosen federal government payer program on that role.

 

Solution

Title: Indian Health Service
Length: 10 pages (2750 Words)
Style: APA

Preview

INDIAN HEALTHCARE SERVICE

The government of Indian is striving to give its population a better healthcare. India can be described as a nation which is multi-ethnic, multi-lingual and pluralistic which has the largest population. For the last ten years, the Indian government has undertaken greater healthcare reforms which consist of different agencies such as worldwide multicultural agencies, health sector reforms, and other stakeholders. Delivering healthcare services to the Indians; which comprise of the larger population comprise great challenges and opportunities to the health care providers. The study of medicine is relatively expensive and time-consuming which eventually discourages many people from enrolling in the medical courses. Political ideologies play a major part on the way through which healthcare services are offered in India through the political decisions made particularly the human resources policy, choice of technology, resources allocation and degree through which the healthcare services are made available to the general population. While it is evident that no healthcare system in the world is stable, the government has a key mandate of fighting against the diseases so that healthful population is achieved. In such regard, the Indian government has prioritized the health system through implementation of different strategies which will be discussed in this essay.

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