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Healthcare Cost And Utilization Project Paper

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HCUP program Healthcare Cost and Utilization Project (HCUP) is a family of databases, software tools and related products developed through a Federal-State-Industry partnership and sponsored by Agency for healthcare research and quality. HCUP enables researchers, insurers, policymakers and other to study healthcare delivery and patient’s outcome over time, and at the national, regional, State and community levels. Healthcare Cost and UtilizationProject include information on in-patient stays, ambulatory surgery and services visits, and emergency department encounter. HCUP is known as the Nation’s most comprehensive source of hospital care data. There are several different database tool used in this program, these databases are based on the data collection efforts of data organizations in the States that are partnered with AHRQ, four of theHCUP databases are: …show more content…

NIS comprises of information on all patients, including individuals covered by Medicare, Medicaid, or private insure, uninsured. NIS information are used to make nationalestimates of healthcare utilization, access, charges, and quality outcomes. NIS have been redesign improve national estimates, most recent changes in 2014 include key features such as: • The NIS is drawn from all States participating in HCUP, representing more than 96j percent of the U.S. population. • The NIS protects patient confidentiality because State and hospital Identifiers are no longer provided. • The new NIS retains a large sample size, which enables analyses of rare conditions, uncommon treatments, and special patient

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HCPCS codes facilitate the procedure of processing health insurance claims made by insurers such as Medicaid. The HCPCS is divided into two levels or classes. The task of classification lies with the Centres of Medicaid and Medicare Services (CMS) in association with the HCPCS work group and other third party payers. Classification is done quarterly, marking a significant step-up from its previous system of annual updates. Since 2014, the CMS has been implementing several changes regarding the continuation of HCSPCS level II.

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Impact of CMS Regulations and Reimbursement Models The Health Care Industry HCM307-1802B-03 Unit 1- Individual Project 1 Michael Green May 22, 2018 Introduction Healing Hands Hospital is preparing financially for the many different reimbursement changes associated with Medicare Advantage Plans. My financial team and I, have been asked to evaluate our current billing and operations workflow processes and incorporate the current trends. We will be discussing how Medicare Advantage affects Healing Hands Hospital, and how we can utilize these trends to maximize patient care. Organizational Budget Reimbursement and financial trends will change go hand and hand.

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Differentiating Roles and Main Activities of CMS and Joint Commission Centers for Medicare Medicaid Services (CMS) is affiliated to the Department of Health and Human Services which oversees federal programs. CMS aims at achieving better quality health care system, reduction of costs and improving health. CMS`s roles and main activities are to administer programs like Medicare and work with States to provide Medicaid. Also provides Children health insurance portability (CHIP), oversees Health Standards and Quality Bureau (HSQB) which “develops, interprets and implements health quality and safety standards and evaluates their impact on the utilization, quality, and cost of health care services”, (Social Security,2015, p.1).,and

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Deb Kanya Initial Post Polit & Beck, (2012) describe Evidence-Based Practice (EBP) as an integration of clinical expertise, patient values, and the best research evidence. One of the more challenging aspects of EBP is the actual research on a particular topic. The fact is there is a multitude of journals and reviews etc. on any given subject; for this reason it is imperative that one knows how to conduct a proper search for pertinent information. Due to the complexity of literature searches and the amount of information available it is prudent to follow a guide while doing research.

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n the article published by the Kaiser Family Foundation on July 14th, 2022, “Americans’ Challenges with Health Care Costs,” Alex Montero shares the issues with health care costs across America and the effects it has on Americans. Research has led the Kaiser Family Foundation (KFF) to learn that the excruciating health care costs are a burden on U.S. families. The KFF shares its research on the public’s experiences with health care costs. On behalf of Montero and others who are a part of the KFF, they share information regarding health care costs impact on Americans. Montero informs the reader that the cost of health care prevents people from getting needed care, that those with lower incomes are highly affected, and many U.S citizens face

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The evolution of managed care organizations has created a dramatic change in our health care system. In 1995, about 161 million American citizens, were enrolled into a managed care organization plan. Some of the plans under the managed care are health maintenance organizations (HMO), preferred provider organizations (PPO), point of service plans (POS), and other networks such as Exclusive Provider Organization (EPO), and union plans. All these plans are different from one another in regards to organization structure, reimbursement for providers, types of services, and care access strategies. However, the goals established by managed care are to reduce and control cost of medical and behavioral health services through case management or care

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A Second Look at the Affordable Care Act David E. Mann, ABA American Military University POLS210 Abstract Since the passing of the Patient Protection and Affordable Care Act (PPACA), twenty-eight states have either filed joint or individual lawsuits to strike down the PPACA. This document will examine a few key elements that the President of the United States must take into consideration when reviewing the act and moving forward to either ratify the act, replace the act, or leave the act as it is. Topics that will be presented will include; the current issues being debated, two competing thoughts on how to fix the ACA, an evaluation of the preferred solution, and finally the responsibility of each level of government. Patient

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The Effects of Regulations on Managed Care and IDS Managed Care is a health care delivery system organized to manage cost. The legal and business imperatives of managed care pervade our national healthcare system, the regulation of managed care depends on who contributes to the plan and who bears the risk for paying for the insured services. More than 170 million Americans receive health care coverage or benefits through some type of "managed care" setting.1 By 2007 about 20 percent of these services are directly provided by a health maintenance organization (HMO), while the majority are served through other managed arrangements, 60 percent in Preferred Provider Organizations (PPO) and 13 percent in Point of Service (POS) plans. Beginning

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Medicaid expansion is still somewhat confusing to me, however I do have an understanding of the requirements such as the income falling between 0-400 percent of the federal poverty level. I also understand that this has become an issue of disparities between states due to expansion. I am partial to each state being able to decide the best options for their citizens. As you stated Emily, I can see how the decision of the state such as whether to expand or not to expand can cause harm to the constituents. I disagree with the philosophy of covering “able-bodied” poor.

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Universal Healthcare Insurance; America’s Choice Today it is a common debate amongst Americans on Universal Healthcare. Universal Healthcare is also referred to as Universal Healthcare Coverage, or, Universal Healthcare Insurance. Universal Healthcare Insurance is a system which provides healthcare and financial protection to all citizens of a particular country. It is believe that Universal Healthcare Insurance will hurt the American economy. Universal Healthcare Insurance will be good for the American economy because there will be a one payer source system, we can get rid of insurance claims submission, high deductibles, claim approval, denials, and providers will be able to make a more concrete diagnosis.

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How “healthy” is American healthcare? Healthcare is one of the most important topics in the United States, because its spending on healthcare per capita is the highest in the world, but outcomes are not necessarily as good. Americans have been complaining about cost of care, and believe that given current regulations which grant companies long period of exclusivity only help increasing drug and equipment prices. Healthcare stays as one of the most important debate topics in the United States and each presidential candidate always addresses this issue. Obama and his administration implemented a new system, which was supposed to make healthcare more affordable and increase coverage, but there are critics who believe that it didn’t serve its purpose and needs to be repealed (Park 14).

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I also support the individual mandate for health insurance coverage, but the cost containment needs a serious attention to make health care more affordable. Without it, cost sharing will be difficult, and the Affordable Care Act (ACA) will be unsustainable. The U.S. is the highest spender on health care per capita among industrialized nations. My friends and family in Japan are always shocked to hear how much I spend on health care in this country. I learned that the ACA addresses several cost containment strategies, such as patient-centered medical homes, accountable care organizations, bundled payments, and programs to reduce readmissions and hospital-acquired conditions.

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Many seem to struggle with the healthcare they receive today. Healthcare seems to have high price for the people that have it today and many soon after receive healthcare end in debt or do not get the care and help they need the money cost can be affordable to some wealthy people but not all so when many people pay for the use of others they do not get the right help and care and good quality they need like most. The people have big opinions on are lowering the costs to it all because many are afraid if they all receive the same care and support given as others because of lower cost that they wont get the good quality they received when only some were able to afford it all and many see it as a negativity because they want for it all to been seen wisely and careful after themselves than to be seen faster than most

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Users of this Software as a Service (SaaS) program include, Accountable Care Organizations; Third Party Administrators; Insurance Companies; Consulting Companies; Hospitals; Self-insured groups; and More The DSS program uses state of the art claim scrubbing, flagging, and medical analytics that offer users an automated approach to detecting what might be considered utilization over-use, fraud or misuse. Ansera uses the pre-eminent sharing platform built by Salesforce world renowned for its outstanding cloud-based services. Using Ansera DSS offers subscribers numerous benefits that include, Avoid penalties for non-compliance Reduce appeals and customer service volume Improve accuracy and implementation of codes and payment policies to speed and help coordinate payments Enhance research, analytics, and longitudinal reporting Decrease errors and the risk of improper payments Enable better monitoring for fraud, waste, and abuse Support foundational healthcare

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Health care cost has seen to increase gradually as years go by. This has been influenced by major factors such as political influence, emerging chronic diseases, new procedures that are coming up including the technologies being invented for treating illnesses, pricing of medicines and treatment is not regulated and when treating ailment their may arise repetition of tests or a patient gets over treated for a particular ailment. The cost of healthcare has increased due to chronic diseases such as cancer and diabetes etc. The lifestyle people are living in this generation has led to the development of diseases that are expensive to treat or has led to there being over treatment in such for a cure of a particular ailment.

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