The ineffective approach in Medicare Reimbursement Issue Analysis Paper Name Institution Abstract The issue of reimbursement is crucial for nurses preparing for advanced roles such as those of management. Of most important is the approach used in arriving at the reimbursement amount in each hospital that APN in managerial roles need to understand while playing their roles…
On the other hand, the support on setting the Medicare reimbursement is that, there is no one general approach in which the most effective amount will be arrived at. In addition, the set guidelines and rules for Medicare reimbursement lack a proper structure making the approach more challenging to the practitioners. Nevertheless, the failure to involve the health practitioners, especially advanced nursing practitioners in management, effectively makes the approach ineffective. Therefore, their involvement is crucial to ensure an approach that suits the needs of all the stakeholders and making it responsive to the needs of both the patients and the healthcare providers. In addition, government intervention by creating proper legal guidelines is crucial to ensure that the approach meets the required needs. Keywords: reimbursement, Medicare, Medicaid The ineffective approach in Medicare Reimbursement Introduction Wong (1999) noted that, the Balanced Budget Act of 1997 provided the reimbursement of APNs for the services they provided in any given setting at a fraction of the physicians fee. Nevertheless, a long process requiring meeting specific guidelines and documentation makes the process of reimbursing APNs hectic and confusing. In this case, the new era of providing medical care should be devoid of the factors that do not in any way help in simplifying the process of reimbursement. Background Reinhardt (2003) identifies the Medicare reimbursement system in the country as a large one and much more centralized than in other countries. Moreover, the inflexible nature of the system does not offer any assistance but only helps make the issue much more complex for advanced practice nurses in management. In this case, this makes the system fail to respond to the local markets conditions, patients’ requirements, and more significantly to nursing care providers’ needs and requirements. Moreover, the unresponsive nature of Medicare is made worse by the rules and guidelines that groups of actors manipulate easily to meet their specific needs. Cohen and Spector (1996) noted that, the annual threat in a considerable cut in Medicare reimbursements often lead to speculation that hospitals will have a limit on the number of Medicare patients they admitted and treated. In effect, advanced nurses in charge of management faced a dilemma whether to admit these patients due to the cut in Medicare considering that the reimbursement formula to determine how much payment a hospital gets is determined by a particular number of cost-related factors and in particular the geographical location and inflationary rates. Position It is my position, as a nurse with advanced preparation in management, that the current Medicare reimbursement system is complex in its effort to offering quality care to the country’s population. In this case, the structure, rules, and guidelines on the reimbursement policy fails to capture the opinions of nursing practitioners on how best to structure the reimbursement policy. On the other hand, the structure of obtaining the reimbursement amount in terms of cost-related measures such as geographical location and inflation makes the policy on reimbursement appear unfair to some states and nurses practitioners while others benefit. In fact, this makes the policy more complex and puts management at an awkward position in terms of implementation of their policies. ...
Cite this document
(“The Ineffective Approach in Medicare Reimbursement Essay”, n.d.)
Retrieved from https://studentshare.net/nursing/52073-reimbursement-and-issue-paper
(The Ineffective Approach in Medicare Reimbursement Essay)
“The Ineffective Approach in Medicare Reimbursement Essay”, n.d. https://studentshare.net/nursing/52073-reimbursement-and-issue-paper.
The program works by providing reimbursement for the services and expenses occurred by inpatient care, doctors services, outpatient care and prescriptions . Individuals pay premiums to be part of the insurance system. This is often provided as part of employment , with spouses also being covered on many occasions .
Accurate information serves as the foundation of a systematic Medicare and Medicaid reimbursement process and contributes to the ease of access in obtaining and sharing information. An associate or reimbursement specialist has the responsibility to make sure that all the necessary information is accurate and that all involved parties agreed and evaluated the reimbursement contract.
The aim of this paper is to discuss why tobacco companies should reimburse the government for health care expenses related to tobacco use. Accountability Tobacco companies have, over the years, created an uncontrollable desire to use tobacco products such as cigarettes.
This is owed to the fact that most of the employees will feel a sense of belonging to the business and consider themselves as being in kind of a family set up in which the needs of an individual is a concern of everyone. Because most employees do expect this move by their employers, it will instill a sense of allegiance by the employees to the business as they will realize that the business organization values upward development of the employees contrary to the general belief about employers (Downey, March, & Berkman, 2007).
The health sector is in a major turmoil due to loss of funds and credibility because of Medicare fraud. In order to analyze the problem and its causes, different stakeholders in the healthcare sector are interested in establishing the extent and the social implication of the problem.
Zwick was hospitalized for mild stroke for 5 days she also qualifies for SNF (Skilled Nursing Facility). Part A is activated when the doctor has ordered the inpatient treatment of an illness and it can only be treated in hospital. Mrs. Zwick is eligible for the SNF since she needed daily skilled care and had developed a hospital related medical condition.
b. Care Facilitation: Supporting work processes of diagnostic and therapeutic activities carried out by separate units, radiology, laboratories, pharmacy, and pathology. These include information department functions intended to support these departments.
The main underlying reasons for the ‘never events’ has basically been the human errors. The term ‘never events’ was coined by the Medicare and Medicaid listed out a number of events that could have been reasonably prevented. This list was
Still on the technology that we employed in my midwifery clinical experience, we utilized the mother baby bracelet. Its main function was to prevent a situation where the mother ends up going with the wrong baby accidentally or
Federal officials have apprehended 16 Metro Detroit heath care officials for being involved in kickback schemes and fraud that amounts to $122 million. The apprehension has been termed as the largest takedown associated with Medicare fraud.
4 Pages(1000 words)Essay
GOT A TRICKY QUESTION? RECEIVE AN ANSWER FROM STUDENTS LIKE YOU!
Let us find you another Essay on topic The Ineffective Approach in Medicare Reimbursement for FREE!