Medicare - Federal Government Payer Program

A health care organization must be recognized as having complied with the participation conditions

or rather the standards that are set forth in the federal regulations, in order to receive payment from and participate in Medicare programs (Cashman & Myers, 2015).

A survey conducted by a state entity on behalf of the federal government is one of the criteria used to determine certification

(Cashman & Myers, 2015). The Centers for Medicare and Medicaid Services (CMS) and the national accrediting group are two examples of such state agencies (Cashman & Myers, 2015). The Joint Commission is one of the examples of a national accrediting organization that has the approval of the CMS as having a survey process and standards that exceeds or meets the requirements for Medicaid.

Accreditation Standards

The accreditation of a health care organization for Medicare is done by the Joint Commission whereby they must exceed r meet the requirements of Medicare and Medicaid (Cashman & Myers, 2015).

How Medicare Influences;

Clinical Quality Reporting Systems

Medicaid has changed the way in which it pays the health care facilities for the services they provide to individuals with Medicare. Instead of the routine of paying the hospitals for the number of services that they provide, Medicare also pays them for the provision of high-quality services (Jones, 2014).

Reimbursement for Health Care Services

Before the Social Security Amendments of 1993, Medicare reimbursed the healthcare facilities on a retrospective cost basis. Today, Medicare controls the reimbursement for health care services through built-in incentives and therefore increasing the efficiency of hospital management (Schlenker & Shaughnessy, 2010).

Patient Access to Care

By reducing the barriers to medical care, Medicare has enabled both the poor and the aging to have access to medical care. According to Jones (2014), the number of Americans enrolled in Medicare today is more than 56 million as compared to the 19 million at the time it was enacted hence proving that it has successfully increased the patient’s access to care.

How Health Information Management Plays a Part in Medicare

The primary objective of Medicare is to high-quality health care for all Americans regardless of their social status. The Health Information Management professional perform critical functions towards the realization of the Medicare objectives safe and high-quality patient care. Existing data from electronic health records, clinical registry, laboratory, and administrative systems provides the necessary information for the improvement of safe and quality care for the patients (Jones, 2014). Effective Health Information Management practices have facilitated the aggregation of this data from several sources and thereby enabling a one-time data capture so that it can be repurposed multiple times (Jones, 2014).

Furthermore, the HIM have four essential practices which are well-thought-out as a fragment of the initiatives for safety and quality patient care. These consist of data standardization, data governance, data capture maintenance and validation, and lastly the data output, analysis, and capture (Jones, 2014). These practices form an essential part of carrying enhancing quality and safety initiatives. According to Jones (2014), Medicare through the CMS have initiated the processes, through HIM, of transformation from a service payer into an active procurer of affordable and high-quality health care.

References

Cashman, J. W., & Myers, B. A. (2015). Medicare: standards of service in a new program--licensure, certification, accreditation. American Journal of Public Health and the Nations Health, 57(7), 1107-1117.

Jones, D. J. (2014). Editorial: Quality Management for the Medicare Generation. American Journal of Medical Quality, 13(3), 109-110.

Schlenker, R. E., & Shaughnessy, P. W. (2010). Medicare Home Health Reimbursement Alternatives. Home Health Care Services Quarterly, 13(1-2), 91-115.