Read the scenario that you will use for the Individual Projects in each week of the course. The Centers for Medicare and Medicaid Services (CMS) has taken on a more visible role in health care delivery. Many changes have transpired to improve patient safety along with the implementation of additional quality metrics, and these changes impact reimbursement rates Likewise, the Patient Protection and Affordable Care Act has changed the reimbursement fee structure of Medicare and Medicaid reimbursement for health care services. Other legislation including the HITECH Act and the Medicare Authorization and CHIP Reactivation Act of 2015 (MACRA) all impact how healthcare organizations receive reimbursement and demonstrate use of data to improve quality and delivery of patient care Mr. Magone, CEO of Healing Hands Hospital, has asked you to join the \"Future of Healing Hands Task Force, and your first assignment is to work with the Hospital Chief Financial Officer, Mr. Johnson, and provide a summary of the current regulations regarding Medicare reimbursement including how MACR impact reimbursement if/when Healing Hands coordinates delivery of services by affiliating with physician practices For this assignment, write a 2-3 page report that you will deliver to Mr. Magone on how the new CMS initiatives and regulations impact the organization\'s revenue structure. In your presentation, address the following questions: Why did CMS become more involved in the reimbursement component of health care? How does CMS\'s involvement impact the reimbursement model for Healing Hands Hospital and other health care organizations If CMS reimbursement regulations for Medicare and Medicaid change, does it follow that other insurance providers change heir policies on reimbursement? What tools can be implemented to ensure organizations such as Healing Hands Hospital and physician practices are meeting the policies and procedures set forth by CMS? Identify 3 tools from the CMS Web site that are helpful in meeting the requirements for Medicare reimbursement set forth by CMS Solution Part-a & part-b: The physician’s work, practice expense, and malpractice, RVU values, CMS (centers for Medicare and Medicaid services) is required to control overall expenditures in health care organization. Therefore, CMS become highly involved in the reimbursement component of health care to patients as per their \"insurance packages\". The CMS\' involvement in “budget Neutrality” & the reimbursement model at Healing Hand hospital & other health care organizations is mainly for physician RVU based payments from Medicare & Medicare that can control its physician costs by adjusting physician payment rates based on “previous periods in a calendar year” as per federal acts and regulations. The Medicare is going to control physicians costs according to “medical procedures and medical visits of their record” in a Jan- 1 ending Dec 31. Conversion Factor is main basis to control the physician costs ac.

1. Read the scenario that you will use for the Individual Projects in each week of the course. The
Centers for Medicare and Medicaid Services (CMS) has taken on a more visible role in health
care delivery. Many changes have transpired to improve patient safety along with the
implementation of additional quality metrics, and these changes impact reimbursement rates
Likewise, the Patient Protection and Affordable Care Act has changed the reimbursement fee
structure of Medicare and Medicaid reimbursement for health care services. Other legislation
including the HITECH Act and the Medicare Authorization and CHIP Reactivation Act of 2015
(MACRA) all impact how healthcare organizations receive reimbursement and demonstrate use
of data to improve quality and delivery of patient care Mr. Magone, CEO of Healing Hands
Hospital, has asked you to join the "Future of Healing Hands Task Force, and your first
assignment is to work with the Hospital Chief Financial Officer, Mr. Johnson, and provide a
summary of the current regulations regarding Medicare reimbursement including how MACR
impact reimbursement if/when Healing Hands coordinates delivery of services by affiliating with
physician practices For this assignment, write a 2-3 page report that you will deliver to Mr.
Magone on how the new CMS initiatives and regulations impact the organization's revenue
structure. In your presentation, address the following questions: Why did CMS become more
involved in the reimbursement component of health care? How does CMS's involvement impact
the reimbursement model for Healing Hands Hospital and other health care organizations If
CMS reimbursement regulations for Medicare and Medicaid change, does it follow that other
insurance providers change heir policies on reimbursement? What tools can be implemented to
ensure organizations such as Healing Hands Hospital and physician practices are meeting the
policies and procedures set forth by CMS? Identify 3 tools from the CMS Web site that are
helpful in meeting the requirements for Medicare reimbursement set forth by CMS
Solution
Part-a & part-b:
The physician’s work, practice expense, and malpractice, RVU values, CMS (centers for
Medicare and Medicaid services) is required to control overall expenditures in health care
organization. Therefore, CMS become highly involved in the reimbursement component of
health care to patients as per their "insurance packages". The CMS' involvement in “budget
Neutrality” & the reimbursement model at Healing Hand hospital & other health care
organizations is mainly for physician RVU based payments from Medicare & Medicare that can
control its physician costs by adjusting physician payment rates based on “previous periods in a
calendar year” as per federal acts and regulations. The Medicare is going to control physicians
costs according to “medical procedures and medical visits of their record” in a Jan- 1 ending Dec

2. 31. Conversion Factor is main basis to control the physician costs according to service coding
system & Medicare physician (provider) fee schedule (MPFS). Physicians costs are controlled by
Medicare based on both “National unadjusted payment” to reimburse medical costs. National
unadjusted payment in which the cost is estimated by “conversion factor i.e. multiplied by the
relative weight unadjusted. There are “nonparticipating physicians” to whom Medicare is going
to control their costs based on treatments given to Medicare beneficiaries & those who accepted
Medicare service assignments. Therefore, insurance providers are not allowed to change their
policies on the reimbursement.
An organizational tool that evaluates the quality of their healthcare services to ensure
organizations such as Healing - Hand hospital & physician practices are meeting the policies.
This evaluation is performed frequently every 4 months in a year to collect information about the
“quality of health serves, health care, physicians and health insurance set by CMS and quality of
clinical care in the regional and public hospitals”. Too often evaluation is going to provide
adequate information about the people perceptions after treatment, at the time of treatment
finally these evaluations reports of “vital signs”, “public surveillance provide information to the
Central government to deliver “health care funding” for health care organizations such as
Medicare programs. In United States, Agency for Healthcare Research and Quality (AHRQ)
often collects information about the health care quality using the Joint Commission. Infrequent
collection of evaluation reports based on health care services often influence regional health care
and may not possible to the central governments to allocate National health service funding to
the respective hospitals, or health care organizations therefore limit health care quality
effectiveness to the public.
The Medicare expenditure project is designed to have you aggressively and realistically deal
with rationing decisions in the area of access for medical care to people from younger to older
age. There is no chance of egress to leave any patients with no medical procedures on age
limitation. Medical expenditure health care resources have been under “allocation” to every
individual patient to maintain a good quality of life within a finite lifespan. Therefore, it is
crucial for physicians, health care professionals to get efficient knowledge about the medical
procedures in a multifaceted approach. This approach is useful to provide patients with
appropriate “medical procedure” with no limitations from pediatric population to geriatric
population. Hence, any limitations such as age, race or any demographic feature should not be a
factor for any medical procedure to implement for patients on “cost basis” and the government
should pay for it for as long as they need it.
Accountable care organization (ACO) positive aspects: It is the management of Medicare
organization jointly held accountable and for quality improvement in medicare.
It has a greater positive aspect in reducing total rate of capital spending growth

3. This organization can provide meticulous population health and satisfaction with essential
medical care.
Challenges to implementation and any major changes required of the current delivery ACO
system:
It has major challenge in complete prevention of illness by chronic disease management and
providing wellness with low cost and more savings. ACO management has produced major
changes of the current prescription delivery system and drug costs in the potential risk sharing
finally elevating scrutiny on medication and care management. ACO has potential ability in
increasing well-developed care to the public by increasing the vital roles of pharmacists. ACO
has greater challenge in improving medication reconciliation associated with transitions of care
along with improved quality measures.
The cost of care impact of the 2004 Aetna hospice decision:
According Patient Protection & Affordable Care Act, Medicare produced beneficial plans to
patients and have implemented approximately 15% reduction in per member in monthly fee and
finally mandated medical loss ratio. Since 2004, Aetna concurrent hospice care, the cost of care
impact with Aetna decision allowing predominantly patients who are suffering from acute &
chronic illness with a 12 month prognosis with low cost to obtain curative care and hospice care
concurrently. Thereby since this decision, meticulous reduction of medical costs have observed
on these patients finally patient admission has increased from 22% to 70%. Hospice care
potentially for patients whose life expectancy of 6 months or some times less and considerably
who put aside conventional treatments