Week #5-To Do List-CCH
Week 5: Introduction
Introduction To Compliance Documentation & Reporting
Proper documentation is an inherent component of delivery of care, not an add-on. One of the oldest battles in healthcare is that between the hospital Medical Records department and the admitting Physician to complete necessary documentation for the Patient’s Chart. The most common cause of loss of admitting privileges has been from this source. This process has only become more important and necessary with the increasing recognition of the importance of proper documentation for legal and ethical defense purposes.
Documentation also serves a number of financial aspects of patient care delivery, including billing, grant writing for research projects, medical research to discover future tests, procedures, and cures, and funding for government supported agencies and programs.
Objectives
To successfully complete this learning unit, you will be expected to:
Identify the uses for health care documentation.
Learn the essential components of quality documentation.
Categorize the document guidelines under the federal False Claims Act.
Identify the documentation required for compliance under the Federal Stark Law.
List the aspects of documentation compliance with regard to electronic health records.
Identify the important issues regarding ethical coding practices.
Learn the most common illegal practices for HIM reporting.
Identify the key concerns under the federal False Claims Act that relate to reporting.
Determine the impact of the Physician Quality Reporting Initiative (PQRI) on HIM processes in physicians’ offices.
Identify the circumstances in which a health care professional is mandated to report a patient’s diagnosis.
Week 5: Discussion
Answer the following questions:
Review the various uses for health care documentation and discuss how each has an impact on the health care delivery system
Discuss procedures you might enact in your facility to avoid violating the False Claims Act
Discuss why physician offices should participate in PQRI
Week 5: Case Study Assignment
Please read and choose one of the following case studies:
Case study on page 111 of your textbook. (This Case Study is in the section for Securing EHR and starts with "NOTE: In each CMP (Civil Monetary Penalties) case resolved through a settlement agreement, . . . ")
Case study on page 127 of your textbook. (This Case Study is in the section for Phantom Patients and starts with "Two Charged in False Claims to Medicaid."
Case study on page 128 of your textbook. (This Case Study is in the section for Services not Performed and starts with "WASHINGTON—April 14, 2008—A board-certified radiologist, Fred Steinberg, M.D., his imaging centers . . ."
Case study on page 131 of your textbook. (This Case Study is in the section for Upcoding and starts with "July 2007: In Florida, a doctor was sentenced to 78 months in prison .
Our group selected a recent annual report for WellPoint We assumed they approached our audit firm to hire us as their new auditor. We performed a preliminary analytical review and risk assessment, and wrote a report indicating to the partner-in-charge our recommendation with respect to this potential client. I completed the preliminary risk analytical review.
The document discusses six trends disrupting the health insurance industry: 1) The chronic disease crisis as chronic diseases account for most healthcare costs and require long-term management. 2) The move to outcomes-based payments to better align incentives with health outcomes. 3) The rise of m-health technologies which empower individuals. 4) Big data revolution allowing personalized insights. 5) Focus on customer centricity in insurance. 6) Pressures on underwriting models from these changes. The document proposes a new model of health insurance that shifts from short-term transactions to long-term partnerships to improve behaviors and health through increased data and alignment of incentives.
hapter 5What Are the Governmental AlternativesThe United StatJeanmarieColbert3
hapter 5
What Are the Governmental Alternatives?
The United States has tried an alphabet soup of health policy options: HSAs, HMOs, IPAs, PPOs, POS plans, ACOs, and so on. Health care analysts often must look beyond specific organizational and financial alternatives and address issues at a higher level and deal with the threads of economic and political thought behind different proposals while considering the overall criteria of access, cost, and quality of care.
Politicians and businesspeople from outside the health care sector advocate many alternatives. To offset their tendency to ignore professional issues, in this chapter we discuss alternatives affecting professional status and roles and institutional responses to them. Table 5-1 presents an array of federal alternatives organized by their primary criteria—access, quality, or cost—and then by the economic philosophies behind them. The items in this array are not intended to be either mutually exclusive or collectively exhaustive; rather, the table provides a framework for looking at both the broad policy picture and specific health care actions taken at various times and places. Later in the chapter, another table (Table 5-3) summarizes policy alternatives added by state and local governments. Many of these alternatives were included as provisions of the Affordable Care Act (ACA). They are still included here, partly because they may be subject to reconsideration in the future.
Table 5-1 Illustrative Federal Government Health Policy Options
Access to Care
• Administered systems
• Universal coverage
• Expand or reduce eligibility or benefits
• Mandate coverage and services
• Captive providers
• Control insurance industry practices
• Mandate employer-based insurance coverage
• Consumer-driven competition
• Implement insurance exchanges
• Encourage basic plans with very low premiums for low-income workers and “young invincibles”
• Mandate individual coverage
• Allow states flexibility to reallocate federal funds for vouchers
• Oligopolistic competition
• Expand or contract coverages in entitlement and categorical programs
• Allow states to reallocate federal uncompensated care funds
• Eliminate ERISA constraints on the states
• Expand the capacity of the system
Quality of Care
• Administered system
• Mandate participation in quality improvement efforts in federal plans and programs
• Add more pay-for-performance incentives
• Select providers and programs on the basis of quality excellence
• Consumer-driven competition
• Encourage or mandate transparency of quality reporting in federal plans and programs
• Oversee licensure and credentialing of foreign-trained providers
• Oligopolistic competition
• Work reporting of quality care and adverse events into purchasing specifications for federal programs and disseminate to the public
• Encourage wider use of health information technology
Cost of Care
• Administered system
• Use full bargaining power in negotiation of ...
The document discusses healthcare reform and its potential repeal. It notes that while repeal seems out of reach currently, many aspects of the law have already taken effect. These include eliminating pre-existing condition exclusions for children, covering dependents until age 26, and minimum loss ratios for insurance companies. The document also discusses the costs and implementation of state health insurance exchanges. It provides the perspective of the author who has advised on the impacts of healthcare reform.
There is broad consensus around the structure of national health reform proposals but disagreements remain around key details. Most proposals include subsidies for lower-income individuals, a health insurance exchange, a mandate for individuals to have coverage, new rules for insurers, and efforts to slow cost growth through payment reforms. However, important questions remain around issues like how much subsidies should cover, who will run the exchange, how affordability will be determined, and how the proposals will be financed without adding to the federal deficit.
This document discusses several common payment mechanisms used in the US healthcare system, including Medicaid/Medicare, out-of-pocket expenses, and preferred provider organizations (PPOs). Medicaid/Medicare accounts for a large portion of US healthcare spending and debt. Patients are also responsible for out-of-pocket costs like co-payments that are rising faster than incomes. PPOs allow patients to choose providers both in and out of their insurance network, and these plans are becoming more popular for Medicare recipients. Billing and payment collection are essential to fund the entire healthcare system.
Mr. Wojcik provides a newsletter update for his clients on various healthcare topics. He explains that he took a break from newsletters to avoid spreading misinformation during the uncertain healthcare reform period. The newsletter includes sections on "Know Your Employee Benefits" tips, healthcare cost analytics, compliance updates, wellness program trends, and industry news. It aims to help clients control costs, workload, and anxiety around benefits.
From the Desk of Mike Wojcik May Newslettermikewojcik
The document is a newsletter from The Horton Group providing updates on healthcare reform and employee benefits topics. It includes summaries of reports on rising healthcare costs, reasons for high US healthcare spending compared to other countries, and a study finding that over half of individual health plans would not meet requirements under the Affordable Care Act. It also lists upcoming topics to be covered in future issues such as prescription drug trends, worksite wellness initiatives, industry news, and notification of upcoming workshops. The newsletter seeks to help clients reduce costs and complexity in healthcare.
Our group selected a recent annual report for WellPoint We assumed they approached our audit firm to hire us as their new auditor. We performed a preliminary analytical review and risk assessment, and wrote a report indicating to the partner-in-charge our recommendation with respect to this potential client. I completed the preliminary risk analytical review.
The document discusses six trends disrupting the health insurance industry: 1) The chronic disease crisis as chronic diseases account for most healthcare costs and require long-term management. 2) The move to outcomes-based payments to better align incentives with health outcomes. 3) The rise of m-health technologies which empower individuals. 4) Big data revolution allowing personalized insights. 5) Focus on customer centricity in insurance. 6) Pressures on underwriting models from these changes. The document proposes a new model of health insurance that shifts from short-term transactions to long-term partnerships to improve behaviors and health through increased data and alignment of incentives.
hapter 5What Are the Governmental AlternativesThe United StatJeanmarieColbert3
hapter 5
What Are the Governmental Alternatives?
The United States has tried an alphabet soup of health policy options: HSAs, HMOs, IPAs, PPOs, POS plans, ACOs, and so on. Health care analysts often must look beyond specific organizational and financial alternatives and address issues at a higher level and deal with the threads of economic and political thought behind different proposals while considering the overall criteria of access, cost, and quality of care.
Politicians and businesspeople from outside the health care sector advocate many alternatives. To offset their tendency to ignore professional issues, in this chapter we discuss alternatives affecting professional status and roles and institutional responses to them. Table 5-1 presents an array of federal alternatives organized by their primary criteria—access, quality, or cost—and then by the economic philosophies behind them. The items in this array are not intended to be either mutually exclusive or collectively exhaustive; rather, the table provides a framework for looking at both the broad policy picture and specific health care actions taken at various times and places. Later in the chapter, another table (Table 5-3) summarizes policy alternatives added by state and local governments. Many of these alternatives were included as provisions of the Affordable Care Act (ACA). They are still included here, partly because they may be subject to reconsideration in the future.
Table 5-1 Illustrative Federal Government Health Policy Options
Access to Care
• Administered systems
• Universal coverage
• Expand or reduce eligibility or benefits
• Mandate coverage and services
• Captive providers
• Control insurance industry practices
• Mandate employer-based insurance coverage
• Consumer-driven competition
• Implement insurance exchanges
• Encourage basic plans with very low premiums for low-income workers and “young invincibles”
• Mandate individual coverage
• Allow states flexibility to reallocate federal funds for vouchers
• Oligopolistic competition
• Expand or contract coverages in entitlement and categorical programs
• Allow states to reallocate federal uncompensated care funds
• Eliminate ERISA constraints on the states
• Expand the capacity of the system
Quality of Care
• Administered system
• Mandate participation in quality improvement efforts in federal plans and programs
• Add more pay-for-performance incentives
• Select providers and programs on the basis of quality excellence
• Consumer-driven competition
• Encourage or mandate transparency of quality reporting in federal plans and programs
• Oversee licensure and credentialing of foreign-trained providers
• Oligopolistic competition
• Work reporting of quality care and adverse events into purchasing specifications for federal programs and disseminate to the public
• Encourage wider use of health information technology
Cost of Care
• Administered system
• Use full bargaining power in negotiation of ...
The document discusses healthcare reform and its potential repeal. It notes that while repeal seems out of reach currently, many aspects of the law have already taken effect. These include eliminating pre-existing condition exclusions for children, covering dependents until age 26, and minimum loss ratios for insurance companies. The document also discusses the costs and implementation of state health insurance exchanges. It provides the perspective of the author who has advised on the impacts of healthcare reform.
There is broad consensus around the structure of national health reform proposals but disagreements remain around key details. Most proposals include subsidies for lower-income individuals, a health insurance exchange, a mandate for individuals to have coverage, new rules for insurers, and efforts to slow cost growth through payment reforms. However, important questions remain around issues like how much subsidies should cover, who will run the exchange, how affordability will be determined, and how the proposals will be financed without adding to the federal deficit.
This document discusses several common payment mechanisms used in the US healthcare system, including Medicaid/Medicare, out-of-pocket expenses, and preferred provider organizations (PPOs). Medicaid/Medicare accounts for a large portion of US healthcare spending and debt. Patients are also responsible for out-of-pocket costs like co-payments that are rising faster than incomes. PPOs allow patients to choose providers both in and out of their insurance network, and these plans are becoming more popular for Medicare recipients. Billing and payment collection are essential to fund the entire healthcare system.
Mr. Wojcik provides a newsletter update for his clients on various healthcare topics. He explains that he took a break from newsletters to avoid spreading misinformation during the uncertain healthcare reform period. The newsletter includes sections on "Know Your Employee Benefits" tips, healthcare cost analytics, compliance updates, wellness program trends, and industry news. It aims to help clients control costs, workload, and anxiety around benefits.
From the Desk of Mike Wojcik May Newslettermikewojcik
The document is a newsletter from The Horton Group providing updates on healthcare reform and employee benefits topics. It includes summaries of reports on rising healthcare costs, reasons for high US healthcare spending compared to other countries, and a study finding that over half of individual health plans would not meet requirements under the Affordable Care Act. It also lists upcoming topics to be covered in future issues such as prescription drug trends, worksite wellness initiatives, industry news, and notification of upcoming workshops. The newsletter seeks to help clients reduce costs and complexity in healthcare.
The document discusses three provisions of the Affordable Care Act (ACA) that address market failures in the health insurance market:
1) Health insurance exchanges allow the uninsured to purchase qualified coverage, addressing missing markets. This increases insurance uptake and lowers overall healthcare expenditures.
2) Guaranteed issue prohibits denying coverage or charging more based on health status, addressing adverse selection. Risk adjustment offsets this by transferring payments between insurers.
3) Consumer protections like online tools provide information to allow informed plan choices, addressing high search costs in a complex market with little transparency.
Health insurance exchanges critical success factors for payersApoorv S
The document discusses the key success factors for payers to succeed in health insurance exchanges established under the Affordable Care Act. It states that payers will need to shift from a B2B model to a B2C model focused on individual consumers. Specifically, payers will need to 1) offer a wide range of cost-effective products tailored for individuals and small groups, 2) have a strong presence in the Medicaid market, 3) invest in care management and wellness programs for the uninsured population, and 4) ensure their technology and operations are ready to support exchanges and new members. The exchanges will significantly impact payers and those who adapt to the new retail environment effectively may lead the industry.
Advertising AssignmentPick a global product brand and co.docxstandfordabbot
Advertising Assignment
Pick a global product / brand and country of interest to you (Do not choose South
Korea). In a 2-page report (double space), compare and contrast how that offering is
advertised in the USA and the foreign market. Please provide your thoughts pro and
con and any questions you have about the differences in marketing practice, as well as
any suggestions / recommendations for potentially doing things better. Source material
for this assignment can be obtained from an internet search and published journal
articles. Please provide a bibliographic list of your references at the back of your paper.
MLA Format.
Please reply to
William Polanco- Rowland–
Please note minimum of 200 words. Please cite one scholarly source. In-text citation should be included.
The cost of healthcare and the associated dollar signs connected to it has kept a certain number of patients away from seeing a doctor when needed. The creation of Managed Care Organizations exists to deal with the exorbitant prices associated with seeing a healthcare provider and actually decreasing costs while increasing the level of care (Nikitas et al, 2020). The common thread is the network of providers that exists within each network that agrees to provide care for the policy holders for an agreed price. Among the Managed Care Organizations are three plans known as Health Maintenance Organization (HMO’s), Preferred Provider Organization(PPO’s), and Point-Of-Service Plan (POS). The structure of HMO’s exists as a network of hospitals, doctors and providers that usually only pay for care in the network visits. These have lower premiums the insured must use a provider within the network that is their Primary Care Physician (PCP). In addition, referrals must be obtained from the PCPs for visits to specialists within the network (healthy.kaiserpermanente.org, 2022) Membership is generally required in the form of employment or one who lives in the area of coverage. With an associated higher cost is the PPO’s. They will allow for visits to in or out of network providers as well as cost of fee coverage for visiting those out of network providers, generally covered by the increased monthly premiums and out of pocket costs (healthy.kaiserpermanente.org, 2022). The third plan being mentioned here is the Point-Of-Service Plan (POS). This is considered a hybrid of plans which allows for the insured to make decisions to see who they want as a provider without first obtaining prior approval. With regard to a plan that works best for the consumer, the HMO plan is one where the nurse within the system is most connected to the providers and the case files allowing for a seamless connection with provider to facility. The other two plans have steps between each provider and information can be lost in the shuffle. The position of nurses working within the healthcare system allows them an opportunity to help keep health costs down via means of self aud.
While the health care reform bill is a step in the right direction, medicare for all or single payer is what is really needed to control costs and insure all.
Consumer-Centric Healthcare: 2015--The Tipping Point Has Arrived (Report by William Blair)
Consumers—in tandem with disruptive healthcare technology and healthcare services providers—are the key to solving many of US healthcare's woes, particularly the unsustainably high cost of care.
Public exchanges, private exchanges, and high-deductible health plans are growing quickly. Disruptive forces of competition will create a lower-cost system that promotes the growth of highly efficient, low-cost, and high-quality providers and technologies.
The continued movement of financial and quality risk back to providers (and increasingly to consumers themselves) is encouraging providers and consumers to seek preventive medicine, cost efficiency, clinical efficacy, and overall value in healthcare. In turn, this could drive significant change regarding the primary point of care delivery (rapidly moving outside the hospital), the overall cost of healthcare and investment decisions made by healthcare providers.
Consumer-centric healthcare providers will experience strong top- and bottom-line growth over the coming years. Investors in both the public and private-equity markets will achieve superior long-term returns by identifying and investing in these companies.
The document summarizes recent studies and trends related to rising healthcare costs in the US. It discusses projections that healthcare spending will grow faster than GDP over the next decade and account for 20% of national spending by 2020. It also outlines strategies that large employers are using to better manage costs, such as engaging employees in wellness programs, linking provider strategies to quality outcomes, and using health technology. Additional sections provide updates on provisions and guidelines under the Affordable Care Act.
The document discusses rising healthcare costs in the US and a new study projecting that health care spending will grow faster than GDP over the next decade. It also summarizes strategies that large employers are using to control costs, such as account-based health plans, engagement of employees in wellness programs, and accountability measures. Updates on the Affordable Care Act include expanded preventive coverage for women and guidelines for employer health subsidies in 2014.
This document discusses Medicare spending and how it has grown significantly since its inception in 1965. It analyzes physician billing data from CMS using the framework of a "three-legged stool" of incentives, decision rights, and performance measurement. It finds disparities in billing amounts across specialties and locations that suggest physicians may respond to financial incentives, with some specialties showing much higher billing in high-cost versus low-cost areas of living. This could be due to unclear medical decisions or anchor institutions setting norms around revenue maximization in those specialties.
Healthcare reform: Five trends to watch as the Affordable Care Act turns fivePwC
In its first five years, the Affordable Care Act (ACA) has had a profound, and likely irreversible, impact on the business of healthcare. Industry leaders must rethink strategies to remain relevant in a post-ACA world.
Web Page: http://www.pwc.com/us/acahealthreform
Online Conference Takes “Deep Dive” into Affordable Care ActPYA, P.C.
PYA’s Martie Ross, Principal, joined three other panelists in a full-day, online conference sponsored by the American Institute of Certified Public Accountants to offer an in-depth look at healthcare reform under the Affordable Care Act (ACA).
The document discusses rising healthcare costs in the US and a new study projecting that healthcare spending will increase substantially over the next decade. It also summarizes strategies that large employers are implementing to better manage costs, such as health improvement programs, engagement of employees, accountability measures, and use of technology. Finally, it provides legislative updates on expanded preventive care coverage for women and subsidies available through the Affordable Care Act.
Segmentation AssignmentSituationCare4US (Care) is a major.docxphilipnelson29183
Segmentation Assignment
Situation
Care4US (Care) is a major health insurer operating in the western part of the United States. It is interested in entering the east coast marketplace and is trying to determine which segment of the health care market it should initially target.
Care’s current market has four segments, described below:
Retail: The retail segment covers private individuals. Care, which does not sell directly to individuals, services this market through Health Insurance Marketplaces, more commonly known as health exchanges. These exchanges are mandated under the Patient Protection and Affordable Care Act (ACA), and are usually state-run organizations offering government regulated and standardized health plans to those eligible for federal subsidies through the ACA. States that decline to offer their own health exchanges offer this insurance through the federal program. Care only offers insurance through the state exchanges, not the federal government, and contracts with each state in its market area offering an exchange. There are six state exchanges Care would be negotiating with in the new market. While many insurers initially signed up to offer insurance through these exchanges, some are finding that the regulations are making it unprofitable for them to offer insurance and are withdrawing from the exchanges. There is limited market growth data as the health exchanges have only been in operation since they were implemented in 2014, but enrollment did grow significantly between 2014 and 2015. Overall this market is expected to be counter-cyclical with the economy, i.e. when the economy is good and unemployment lower, more people are expected to have insurance through their employers and fewer from the health exchanges, and vice versa.
Employer: Most people have health insurance through their employers. Insurance companies offer a variety of group plans to companies and organizations, which choose the options best (and most cost-effectively) suited for their workforces. It should be noted that under the ACA, employers with more than 50 employees are required to offer health care to their employees; those who work for employers with less than 50 employees who do not offer health care can obtain it through the health exchanges. Care offers a variety of products to companies and organizations using its own sales force, who sell directly to employers in Care’s market. Insurance sales to employers took a jump under the provisions of the ACA as smaller employers were forced to add health insurance for their employees; sales have leveled off since then and are expected to follow economic and employment trends.
Military: The military provides health benefits to active personnel, retirees, and dependents through Tricare, a Department of Defense (DoD) administered program. The DoD contracts with private companies on a regional basis to provide this insurance. Insurers negotiate directly with the DoD to be the sole Trica.
Implications for The Medicare Program Discussion.docx4934bk
This document discusses implications for the Medicare program given demographic trends in the aging US population. It outlines 10 issues arising from an increasing senior population and the implications for Medicare delivery and costs. It also discusses potential solutions to issues providing healthcare for seniors, including maintaining the political and fiscal viability of Medicare in the future.
1) The payment models in healthcare are shifting from fee-for-service to value-based models that tie reimbursement to quality outcomes and cost savings. This transition is being driven by rising healthcare costs, the Affordable Care Act, and commercial insurers.
2) Providers now need to accelerate preparations for managing clinical and financial risk through value-based contracts. This requires changes to business models, physician alignment, and supporting patients through the transition.
3) For organizations to succeed under value-based contracts, they must define population health strategies, implement coordinated care delivery models, and carefully sequence clinical and financial transformations to capture savings while maintaining stability.
White Paper - Internet Marketing Strategies For The Medical Device Industryjerryme5
This is a White Paper that I wrote, while employed at Exemplum, that talks about various marketing strategies that medical device companies can use to leverage the Internet to market their products more effectivelty.
Attaining Expertise
You are training individuals you supervise on how to attain expertise in your field.
Write
a 1,050- to 1,200-word paper on the processes involved with attaining expertise, using your assigned readings in Anderson. Explain how these processes apply to attaining expertise in your current field or in the field you plan to enter. Focus on the cognitive processes that are involved in mastering knowledge and skills.
Include
a title page and references list consistent with APA guidelines.
Click
the Assignment Files tab to submit your assignment.
.
attachment Chloe” is a example of the whole packet. Please follow t.docxcelenarouzie
This document provides instructions for writing a PR packet that includes a pitch letter, news release, feature release, fact sheet, executive biography, and media alert following the example and format provided in the attachment. The writer has already completed the news release part of the packet and included it in the attached example for reference in completing the rest of the packet.
AttachmentFor this discussionUse Ericksons theoretic.docxcelenarouzie
Attachment
For this discussion:
Use Erickson's theoretical framework to explore adolescent attachment and its developmental impact.
Choose two issues related to adolescent attachment (for example, attachment relationships with parents and peers, or the nature of attachment system in adolescence) and describe possible implications for adult life.
Support your response with APA-formatted citations from scholarly sources, including both those provided in this unit and any additional evidence you may have researched.
.
Attachment and Emotional Development in InfancyThe purpose o.docxcelenarouzie
Attachment and Emotional Development in Infancy
The purpose of this discussion is to consider the stages of attachment from birth to one year, and emotional development and psychosocial crisis in infancy.
Briefly discuss attachment patterns and what you see as the most significant impact on the development of attachment.
Describe strategies that caretakers can implement to promote the child's ability to regulate emotions as he or she develops.
Remember to appropriately cite any resources, including the textbook, that you use to support your thinking in your initial post.
.
ATTACHEMENT from 7.1 and 7.2 Go back to the Powerpoint for thi.docxcelenarouzie
ATTACHEMENT from 7.1 and 7.2
Go back to the Powerpoint for this week and reread slides 12 and 13
Select at least 5 bullet points that you think are important because they affect the way justice is carried out in the State and or at the local level.
Write your entry explaining why you chose those 5 elements. Why are they important. What would you change?
.
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The document discusses three provisions of the Affordable Care Act (ACA) that address market failures in the health insurance market:
1) Health insurance exchanges allow the uninsured to purchase qualified coverage, addressing missing markets. This increases insurance uptake and lowers overall healthcare expenditures.
2) Guaranteed issue prohibits denying coverage or charging more based on health status, addressing adverse selection. Risk adjustment offsets this by transferring payments between insurers.
3) Consumer protections like online tools provide information to allow informed plan choices, addressing high search costs in a complex market with little transparency.
Health insurance exchanges critical success factors for payersApoorv S
The document discusses the key success factors for payers to succeed in health insurance exchanges established under the Affordable Care Act. It states that payers will need to shift from a B2B model to a B2C model focused on individual consumers. Specifically, payers will need to 1) offer a wide range of cost-effective products tailored for individuals and small groups, 2) have a strong presence in the Medicaid market, 3) invest in care management and wellness programs for the uninsured population, and 4) ensure their technology and operations are ready to support exchanges and new members. The exchanges will significantly impact payers and those who adapt to the new retail environment effectively may lead the industry.
Advertising AssignmentPick a global product brand and co.docxstandfordabbot
Advertising Assignment
Pick a global product / brand and country of interest to you (Do not choose South
Korea). In a 2-page report (double space), compare and contrast how that offering is
advertised in the USA and the foreign market. Please provide your thoughts pro and
con and any questions you have about the differences in marketing practice, as well as
any suggestions / recommendations for potentially doing things better. Source material
for this assignment can be obtained from an internet search and published journal
articles. Please provide a bibliographic list of your references at the back of your paper.
MLA Format.
Please reply to
William Polanco- Rowland–
Please note minimum of 200 words. Please cite one scholarly source. In-text citation should be included.
The cost of healthcare and the associated dollar signs connected to it has kept a certain number of patients away from seeing a doctor when needed. The creation of Managed Care Organizations exists to deal with the exorbitant prices associated with seeing a healthcare provider and actually decreasing costs while increasing the level of care (Nikitas et al, 2020). The common thread is the network of providers that exists within each network that agrees to provide care for the policy holders for an agreed price. Among the Managed Care Organizations are three plans known as Health Maintenance Organization (HMO’s), Preferred Provider Organization(PPO’s), and Point-Of-Service Plan (POS). The structure of HMO’s exists as a network of hospitals, doctors and providers that usually only pay for care in the network visits. These have lower premiums the insured must use a provider within the network that is their Primary Care Physician (PCP). In addition, referrals must be obtained from the PCPs for visits to specialists within the network (healthy.kaiserpermanente.org, 2022) Membership is generally required in the form of employment or one who lives in the area of coverage. With an associated higher cost is the PPO’s. They will allow for visits to in or out of network providers as well as cost of fee coverage for visiting those out of network providers, generally covered by the increased monthly premiums and out of pocket costs (healthy.kaiserpermanente.org, 2022). The third plan being mentioned here is the Point-Of-Service Plan (POS). This is considered a hybrid of plans which allows for the insured to make decisions to see who they want as a provider without first obtaining prior approval. With regard to a plan that works best for the consumer, the HMO plan is one where the nurse within the system is most connected to the providers and the case files allowing for a seamless connection with provider to facility. The other two plans have steps between each provider and information can be lost in the shuffle. The position of nurses working within the healthcare system allows them an opportunity to help keep health costs down via means of self aud.
While the health care reform bill is a step in the right direction, medicare for all or single payer is what is really needed to control costs and insure all.
Consumer-Centric Healthcare: 2015--The Tipping Point Has Arrived (Report by William Blair)
Consumers—in tandem with disruptive healthcare technology and healthcare services providers—are the key to solving many of US healthcare's woes, particularly the unsustainably high cost of care.
Public exchanges, private exchanges, and high-deductible health plans are growing quickly. Disruptive forces of competition will create a lower-cost system that promotes the growth of highly efficient, low-cost, and high-quality providers and technologies.
The continued movement of financial and quality risk back to providers (and increasingly to consumers themselves) is encouraging providers and consumers to seek preventive medicine, cost efficiency, clinical efficacy, and overall value in healthcare. In turn, this could drive significant change regarding the primary point of care delivery (rapidly moving outside the hospital), the overall cost of healthcare and investment decisions made by healthcare providers.
Consumer-centric healthcare providers will experience strong top- and bottom-line growth over the coming years. Investors in both the public and private-equity markets will achieve superior long-term returns by identifying and investing in these companies.
The document summarizes recent studies and trends related to rising healthcare costs in the US. It discusses projections that healthcare spending will grow faster than GDP over the next decade and account for 20% of national spending by 2020. It also outlines strategies that large employers are using to better manage costs, such as engaging employees in wellness programs, linking provider strategies to quality outcomes, and using health technology. Additional sections provide updates on provisions and guidelines under the Affordable Care Act.
The document discusses rising healthcare costs in the US and a new study projecting that health care spending will grow faster than GDP over the next decade. It also summarizes strategies that large employers are using to control costs, such as account-based health plans, engagement of employees in wellness programs, and accountability measures. Updates on the Affordable Care Act include expanded preventive coverage for women and guidelines for employer health subsidies in 2014.
This document discusses Medicare spending and how it has grown significantly since its inception in 1965. It analyzes physician billing data from CMS using the framework of a "three-legged stool" of incentives, decision rights, and performance measurement. It finds disparities in billing amounts across specialties and locations that suggest physicians may respond to financial incentives, with some specialties showing much higher billing in high-cost versus low-cost areas of living. This could be due to unclear medical decisions or anchor institutions setting norms around revenue maximization in those specialties.
Healthcare reform: Five trends to watch as the Affordable Care Act turns fivePwC
In its first five years, the Affordable Care Act (ACA) has had a profound, and likely irreversible, impact on the business of healthcare. Industry leaders must rethink strategies to remain relevant in a post-ACA world.
Web Page: http://www.pwc.com/us/acahealthreform
Online Conference Takes “Deep Dive” into Affordable Care ActPYA, P.C.
PYA’s Martie Ross, Principal, joined three other panelists in a full-day, online conference sponsored by the American Institute of Certified Public Accountants to offer an in-depth look at healthcare reform under the Affordable Care Act (ACA).
The document discusses rising healthcare costs in the US and a new study projecting that healthcare spending will increase substantially over the next decade. It also summarizes strategies that large employers are implementing to better manage costs, such as health improvement programs, engagement of employees, accountability measures, and use of technology. Finally, it provides legislative updates on expanded preventive care coverage for women and subsidies available through the Affordable Care Act.
Segmentation AssignmentSituationCare4US (Care) is a major.docxphilipnelson29183
Segmentation Assignment
Situation
Care4US (Care) is a major health insurer operating in the western part of the United States. It is interested in entering the east coast marketplace and is trying to determine which segment of the health care market it should initially target.
Care’s current market has four segments, described below:
Retail: The retail segment covers private individuals. Care, which does not sell directly to individuals, services this market through Health Insurance Marketplaces, more commonly known as health exchanges. These exchanges are mandated under the Patient Protection and Affordable Care Act (ACA), and are usually state-run organizations offering government regulated and standardized health plans to those eligible for federal subsidies through the ACA. States that decline to offer their own health exchanges offer this insurance through the federal program. Care only offers insurance through the state exchanges, not the federal government, and contracts with each state in its market area offering an exchange. There are six state exchanges Care would be negotiating with in the new market. While many insurers initially signed up to offer insurance through these exchanges, some are finding that the regulations are making it unprofitable for them to offer insurance and are withdrawing from the exchanges. There is limited market growth data as the health exchanges have only been in operation since they were implemented in 2014, but enrollment did grow significantly between 2014 and 2015. Overall this market is expected to be counter-cyclical with the economy, i.e. when the economy is good and unemployment lower, more people are expected to have insurance through their employers and fewer from the health exchanges, and vice versa.
Employer: Most people have health insurance through their employers. Insurance companies offer a variety of group plans to companies and organizations, which choose the options best (and most cost-effectively) suited for their workforces. It should be noted that under the ACA, employers with more than 50 employees are required to offer health care to their employees; those who work for employers with less than 50 employees who do not offer health care can obtain it through the health exchanges. Care offers a variety of products to companies and organizations using its own sales force, who sell directly to employers in Care’s market. Insurance sales to employers took a jump under the provisions of the ACA as smaller employers were forced to add health insurance for their employees; sales have leveled off since then and are expected to follow economic and employment trends.
Military: The military provides health benefits to active personnel, retirees, and dependents through Tricare, a Department of Defense (DoD) administered program. The DoD contracts with private companies on a regional basis to provide this insurance. Insurers negotiate directly with the DoD to be the sole Trica.
Implications for The Medicare Program Discussion.docx4934bk
This document discusses implications for the Medicare program given demographic trends in the aging US population. It outlines 10 issues arising from an increasing senior population and the implications for Medicare delivery and costs. It also discusses potential solutions to issues providing healthcare for seniors, including maintaining the political and fiscal viability of Medicare in the future.
1) The payment models in healthcare are shifting from fee-for-service to value-based models that tie reimbursement to quality outcomes and cost savings. This transition is being driven by rising healthcare costs, the Affordable Care Act, and commercial insurers.
2) Providers now need to accelerate preparations for managing clinical and financial risk through value-based contracts. This requires changes to business models, physician alignment, and supporting patients through the transition.
3) For organizations to succeed under value-based contracts, they must define population health strategies, implement coordinated care delivery models, and carefully sequence clinical and financial transformations to capture savings while maintaining stability.
White Paper - Internet Marketing Strategies For The Medical Device Industryjerryme5
This is a White Paper that I wrote, while employed at Exemplum, that talks about various marketing strategies that medical device companies can use to leverage the Internet to market their products more effectivelty.
Similar to Week #5-To Do List-CCHWeek 5 IntroductionIntroduction To Co.docx (16)
Attaining Expertise
You are training individuals you supervise on how to attain expertise in your field.
Write
a 1,050- to 1,200-word paper on the processes involved with attaining expertise, using your assigned readings in Anderson. Explain how these processes apply to attaining expertise in your current field or in the field you plan to enter. Focus on the cognitive processes that are involved in mastering knowledge and skills.
Include
a title page and references list consistent with APA guidelines.
Click
the Assignment Files tab to submit your assignment.
.
attachment Chloe” is a example of the whole packet. Please follow t.docxcelenarouzie
This document provides instructions for writing a PR packet that includes a pitch letter, news release, feature release, fact sheet, executive biography, and media alert following the example and format provided in the attachment. The writer has already completed the news release part of the packet and included it in the attached example for reference in completing the rest of the packet.
AttachmentFor this discussionUse Ericksons theoretic.docxcelenarouzie
Attachment
For this discussion:
Use Erickson's theoretical framework to explore adolescent attachment and its developmental impact.
Choose two issues related to adolescent attachment (for example, attachment relationships with parents and peers, or the nature of attachment system in adolescence) and describe possible implications for adult life.
Support your response with APA-formatted citations from scholarly sources, including both those provided in this unit and any additional evidence you may have researched.
.
Attachment and Emotional Development in InfancyThe purpose o.docxcelenarouzie
Attachment and Emotional Development in Infancy
The purpose of this discussion is to consider the stages of attachment from birth to one year, and emotional development and psychosocial crisis in infancy.
Briefly discuss attachment patterns and what you see as the most significant impact on the development of attachment.
Describe strategies that caretakers can implement to promote the child's ability to regulate emotions as he or she develops.
Remember to appropriately cite any resources, including the textbook, that you use to support your thinking in your initial post.
.
ATTACHEMENT from 7.1 and 7.2 Go back to the Powerpoint for thi.docxcelenarouzie
ATTACHEMENT from 7.1 and 7.2
Go back to the Powerpoint for this week and reread slides 12 and 13
Select at least 5 bullet points that you think are important because they affect the way justice is carried out in the State and or at the local level.
Write your entry explaining why you chose those 5 elements. Why are they important. What would you change?
.
Attached the dataset Kaggle has hosted a data science competitio.docxcelenarouzie
Attached the dataset
Kaggle has hosted a data science competition to predict category of crime in San Francisco based on 12 years (From 1934 to 1963) of crime reports from across all of San Francisco’s neighborhoods (time, location and other features are given).
I would like you to explore the dataset attached visually using Tableau and uncover hidden trends:
Are there specific clusters with higher crime rates?
Are there yearly/ Monthly/ Daily/ Hourly trends?
Is Crime distribution even across all geographical areas or different?
.
Attached you will find all of the questions.These are just like th.docxcelenarouzie
Attached you will find all of the questions.
These are just like the others I put up before. they need to be awnsered individually. Please use APA format with in text citations and references. My book is at least required as one of the references:
Harr, J. S., Hess, M. H., & Orthmann, C. H. (2012).
Constitutional law and the criminal justice system
(5th ed.). Belmont, CA: Wadsworth.
This assignment needs to be done by Friday by 11:00 P.M Eastern Time.
.
Attached the dataset Kaggle has hosted a data science compet.docxcelenarouzie
Attached the dataset
Kaggle has hosted a data science competition to predict category of crime in San Francisco based on 12 years (From 1934 to 1963) of crime reports from across all of San Francisco’s neighborhoods (time, location and other features are given).
I would like you to explore the dataset attached visually using Tableau and uncover hidden trends:
Are there specific clusters with higher crime rates?
Are there yearly/ Monthly/ Daily/ Hourly trends?
Is Crime distribution even across all geographical areas or different?
.
B. Answer Learning Exercises Matching words parts 1, 2, 3,.docxcelenarouzie
B. Answer Learning Exercises
* Matching words parts 1, 2, 3, and 4
* Definitions
*Matching Terms and Definitions 1, 2
C. Answer the following questions base in chapter 1:
1. Define Word root, mention 5 examples.
2. Define Suffixes, mention 5 examples.
3. Define Prefixes, mention 5 examples.
4. Some prefixes are confusing because they are similar in spelling, but opposite in meaning, those are call Contrasting Prefixes; mention 5 examples and their meaning.
.
B)What is Joe waiting for in order to forgive Missy May in The Gild.docxcelenarouzie
B)What is Joe waiting for in order to forgive Missy May in “The Gilded Six-Bits”? How does period of deliberation affect his forgiveness of her – does it make more of less sincere? What does this say about their relationship going into the future?
C) How is Dave in “The Man Who Was Almost A Man” not a man? Is there one central force preventing him from becoming a man? How does he go about overcoming this? Is it even possible for him to do so?
.
B)Blanche and Stella both view Stanley very differently – how do the.docxcelenarouzie
B)Blanche and Stella both view Stanley very differently – how do they see him and what does this view say about themselves? What causes Stella to continue to return to Stanley? Does she really trust him? Does she ultimately sacrifice her sister for him?
C) What is the difference between how Blanche presents herself and what she really is? Why does she choose to present herself so differently?
250 words each
.
b) What is the largest value that can be represented by 3 digits usi.docxcelenarouzie
b) What is the largest value that can be represented by 3 digits using radix-3?
c) Why do you think that binary logic is much more commonly used than ternary logic? Be brief.
The ASCII code for the letter E is 1000101, and the ASCII code for the letter e is 1100101. Given that the ASCII code for the letter M is 1001101, without looking at Table 2.7, what is the ASCII code for the letter m?
.
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B A S I C L O G I C M O D E L D E V E L O P M E N T Pr.docxcelenarouzie
B A S I C L O G I C M O D E L D E V E L O P M E N T
Produced by The W. K. Kellogg Foundation
53535353
Developing a Basic Logic
Model For Your Program
Drawing a picture of how your program will achieve results
hether you are a grantseeker developing a proposal for start-up funds or a
grantee with a program already in operation, developing a logic model can
strengthen your program. Logic models help identify the factors that will
impact your program and enable you to anticipate the data and resources
you will need to achieve success. As you engage in the process of creating your
program logic model, your organization will systematically address these important
program planning and evaluation issues:
• Cataloguing of the resources and actions you believe you will need to reach intended
results.
• Documentation of connections among your available resources, planned activities and
the results you expect to achieve.
• Description of the results you are aiming for in terms of specific, measurable, action-
oriented, realistic and timed outcomes.
The exercises in this chapter gather the raw material you need to draw a basic logic
model that illustrates how and why your program will work and what it will accomplish.
You can benefit from creating a logic model at any point in the life of any program.
The logic model development process helps people inside and outside your
organization understand and improve the purpose and process of your work.
Chapter 2 is organized into two sections—Program Implementation, and Program
Results. The best recipe for program success is to complete both exercises. (Full-size
masters of each exercise and the checklists are provided in the Forms Appendix at the
back of the guide for you to photocopy and use with stakeholder groups as you design
your program.)
Exercise 1: Program Results. In a series of three steps, you describe the results you
plan to achieve with your program.
Exercise 2: Program Resources and Activities by taking you through three steps
that connect the program’s resources to the actual activities you plan to do.
Chapter
2
W
B A S I C L O G I C M O D E L D E V E L O P M E N T
Produced by The W. K. Kellogg Foundation
54545454
The Mytown Example
Throughout Exercises 1 and 2 we’ll follow an example program to see how the logic
model steps can be applied. In our example, the folks in Mytown, USA are striving to
meet the needs of growing numbers of uninsured residents who are turning to Memorial
Hospital’s Emergency Room for care. Because that care is expensive and not the best
way to offer care, the community is working to create a free clinic. Throughout the
chapters, Mytown’s program information will be dropped into logic model templates for
Program Planning, Implementation, and Evaluation.
Novice Logic modelers may want to have copies of the Basic Logic Model Template in
front of them and follow along. Those read.
B H1. The first issue that jumped out to me is that the presiden.docxcelenarouzie
B H
1. The first issue that jumped out to me is that the president and two vice presidents were the ones to develop the program. Our lecture notes and the text tell us that safety is one topic where management and employees can usually come to an agreement. Everyone wants a safe work environment. We are also taught that consultation is the best way to approach health and safety at work. Again, this means involving more than three people at the company. For starters, I would recommend that the safety program be dismantled and reconstructed by a committee consisting of at least 50% employees, not just senior leadership. I would keep this committee as small as possible and not have it controlled by one person only. The committee should be formed of employees from all sections and representing all possible departments where health and safety are potential issues.
2. The first issue that jumped out to me is that the president and two vice presidents were the ones to develop the program. Our lecture notes and the text tell us that safety is one topic where management and employees can usually come to an agreement. Everyone wants a safe work environment. We are also taught that consultation is the best way to approach health and safety at work. Again, this means involving more than three people at the company. For starters, I would recommend that the safety program be dismantled and reconstructed by a committee consisting of at least 50% employees, not just senior leadership. I would keep this committee as small as possible and not have it controlled by one person only. The committee should be formed of employees from all sections and representing all possible departments where health and safety are potential issues.
N S
1. 1.Top of Form
There could be a number of problems with CMI's safety awareness plan. One major one is that they could not be promoting safety. That is the first step into getting the program to work...employee involvement. First the awareness program was developed by the president and the vice presidents. A safety awareness program can be more successful if employees are involved in the development, and remain involved as it is adjusted and refined. Rules should be in place, and employers must ensure that those rules are followed and enforced consistently. Incentives and competition could be another way to promote safety in the work place. Our text cites that having employees work in teams and have them determine the incentives will keep them involved and promote safety. Also, of course keeping employees up to date on all rules will also promote safety.
2. I think the supervisor's response to employee complaints about John Randall is not appropriate at all. Even thought it is difficult, home problems should not be brought into the work place. Especially if coworkers are complaining about someone's behavior. This does not promote safety at all. To say that Randall will get over it and to disclose that he has personal problems is.
b l u e p r i n t i CONSUMER PERCEPTIONSHQW DQPerception.docxcelenarouzie
b l u e p r i n t i CONSUMER PERCEPTIONS
HQW DQ
Perceptions Impact
Your Market?
By Nicole Olynk Widmar and
Melissa McKendree, Purdue University
I aintaining existing mar-
kets for pork products,
I cultivating new markets
for existing products and
creating new products for new markets
are some avenues that the U.S. pork
industry has sought, and continues to
explore, for growth. When it comes to
maintaining markets, there are several
relationships that must be considered.
End consumers, whether in restaurant
or supermarket settings, are increas-
ingly interested in social issues and the
production processes employed in food
production. Livestock products (meat
and dairy products) certainly seem
to get the majority of the spotlight in
regard to consumers' concern for pro-
duction processes.
Shoppers in supermarkets and din-
ers in restaurants have increased access
to information via the Internet, and are
in constant communication with one
another via social media and alterna-
tive news sources about perceptions
of animal agriculture. Even though
most U.S. consumers are not directly
in contact with livestock, concern for
the treatment of animals, including
those employed in food production,
is evident — and increasing. While
in the past consumers were mainly
concerned with factors like the fat or
nutritional content of pork, for exam-
ple, today's savvy shoppers are con-
sidering other factors, like the welfare
of livestock (pigs), safety of workers
employed on farms and potential envi-
ronmental impacts (externalities) of
livestock operations.
Large-scale changes in production
practices are taking place in livestock
24 April 15, 2014
production due to pressures from vari-
ous interested parties. Changes such
as the discontinued use of gestation
stalls, for example, are being sought
via traditional regulatory channels in
some states, but are also being pushed
via non-traditional market channels.
Consider the cumbersome process
of changing regulations, versus the
oftentimes faster (and perhaps easier)
channel of influencing key market
actors. It is no surprise that consum-
ers' concerns are increasingly voiced to
supermarkets and restaurants which,
in turn, take action to satisfy their
customers by placing pressure on sup-
ply-chain players. Changes sought via
"the market," rather than legislation or
regulation, are increasingly common,
and the use of market channels for
communicating throughout the supply
chain is unlikely to stop anytime soon.
www.nationalhogfarmer.com
Figure 1. Reported Recollection of Exposure to Media
Stories Regarding Pig Welfare, by Source
7 0 %
0 %
Television Internet
Media source
Printed Magazines
Newspaper
Books I have not seen
any media stories
regarding pig
welfare.
Melissa McKendree (left) and Nicole Olynk Widmar
A national-scale study completed
at Purdue University by Nicole Olynk
Widmar, Melissa McKendree, and
Candace Croney in 2013 was focused
on assessing consumers' perceptions of
various por.
B R O O K I N G SM E T R O P O L I TA N P O L I CY .docxcelenarouzie
B R O O K I N G S
M E T R O P O L I TA N
P O L I CY
P R O G RA M
6
I . I N T R O D U C T I O N
A
s the global economy has become more integrated and urbanized,
fueled in large part by technology, major cities and metropolitan
areas have become key engines of economic growth. The 123 largest
metro areas in the world generate nearly one third of global output
with only 13 percent of the world’s population.
In this urban-centered world, the classic notion of a
global city has been upended. This report introduces
a redefined map of global cities, drawing on a new
typology that demonstrates how metro areas vary in
the ways they attract and amass economic drivers
and contribute to global economic growth in distinct
ways. New concerns about economic stagnation—in
both developing and developed economies—add
urgency to mapping the role of the world’s cities and
the extent to which they are well-positioned to deliver
the next round of global growth.1
Instead of a ranking or indexed score, which many
prior cities indices and reports have capably deliv-
ered,2 this analysis differentiates the assets and
challenges faced by seven types of global cities.
This perspective reveals that all major cities are
indeed global; they participate as critical nodes in
an integrated marketplace and are shaped by global
currents. But cities also operate from much differ-
ent starting points and experience diverse economic
trajectories. Concerns about global growth, productiv-
ity, and wages are not monolithic, and so this typology
can inform the variety of paths cities take to address
these challenges. For metro leaders, this typology
can also ensure better application of peer com-
parisons, enable the identification of more relevant
global innovations to local challenges, and reinforce a
city-region’s relative role and performance to inform
economic strategies that ensure ongoing prosperity.
This report proceeds in four parts. In the following
section, Part II, we explore the three global forces of
urbanization, globalization, and technological change,
and how together they are demanding that city-
regions focus on five core factors—traded clusters,
innovation, talent, infrastructure connectivity, and
governance—to bolster their economic competitive-
ness. Building on these factors, Part III outlines the
data and methods deployed to create the metropoli-
tan typology. Part IV explores the collective economic
clout of the metro areas in our sample and introduces
the new typology of global cities. Finally, Part V
explores the future investments, policies, and strate-
gies required for each grouping of metro areas. Within
the typology framework, we explore the priorities for
action going forward, including the implications for
governance.
REDEFINING
GLOBAL CITIES
THE SEVEN TYPES
OF GLOBAL METRO
ECONOMIES
7
U R B A N I Z AT I O N
The world is becoming more urba.
B L O C K C H A I N & S U P P LY C H A I N SS U N I L.docxcelenarouzie
B L O C K C H A I N &
S U P P LY C H A I N S
S U N I L W A T T A L
T E M P L E U N I V E R S I T Y
• To understand the power of blockchain systems, and the things they can do, it is important to
distinguish between three things that are commonly muddled up, namely the bitcoin currency,
the specific blockchain that underpins it and the idea of blockchains in general.
• Economist, 2015
WHAT IS BLOCKCHAIN?
• A technology that permits transactions to be recorded
– Cryptographically chains blocks in order
– Allows resulting ledger accessed by different servers
– Information stored can never be deleted
• A digital distributed ledger that is stored and maintained on multiple systems belonging to multiple
entities sharing identical information (Deloitte)
• Bitcoin was the first demonstrable use
HISTORY OF BLOCKCHAIN
T YPES OF BLOCKCHAINS
• public or permissionless blockchains
– everyone who wants to engage in the network can openly see all transactions. The technology is
transparent, and all who want to engage in making transactions on the blockchain can do so.
• private or permissioned blockchains
– closed and accessible only to a selected few who have permission to engage in the blockchain.
BLOCKCHAIN FEATURES
• A blockchain lets us agree on the state of the system, even if we don’t all trust each other!
• We don’t want a single trusted arbiter of the state of the world.
• A blockchain is a hash chain with some other stuff added
– Validity conditions
– Way to resolve disagreements
• The spread of blockchains is bad for anyone in the “trust business”
WHAT IS BITCOIN
• A protocol that supports a decentralized, pseudo-anonymous, peer-to-peer digital currency
• A publicly disclosed linked ledger of transactions stored in a blockchain
• A reward driven system for achieving consensus (mining) based on “Proofs of Work” for
helping to secure the network
• A “scare token” economy with an eventual cap of about 21M bitcoins
10
OTHER USES OF BLOCKCHAIN
• Supply Chain
• Online advertising
• Smart Contracts
• Voting
BENEFITS OF BLOCKCHAIN
• Consistent
• Democratic
• Secure and accurate
• Segmented and private
• Permanent and tamper resistant
• Quickly updated
• Intelligent – smart contracts
BARRIERS TO BLOCKCHAIN
ADOPTION
• Hype
• Finding the right balance in regulation
• Cybersecurity
• Ease of use over shared databases
• Lack of understanding and knowledge
SUPPLY CHAIN CHALLENGES
• Margin Erosion
• Demand changes
• Ripple Effect
• Supply Chain Risk Management
• Lack of end to end visibility
• Obsolescence of Technology
APPLICATIONS IN SUPPLY CHAINS
• Traceability
• International Trade
• Continuity of Information
• Data Analytics
• Visibility
• Digital contracts and payments
• Check fraud and gaming
EX AMPLES OF BLOCKCHAIN IN
SUPPLY CHAINS
• 300 Cubits
– Blokcchain technology for the shipping industry
• BanQu
– Payment for small businesses
• Bext360
– Social sustainability.
Año 15, núm. 43 enero – abril de 2012. Análisis 97 Orien.docxcelenarouzie
Año 15, núm. 43 / enero – abril de 2012. Análisis 97
Orientalizing New Spain:
Perspectives on Asian Influence
in Colonial Mexico1
Edward R. Slack, Jr.2
Resumen
E ste artículo investiga la totalidad de la influencia de Asia sobre la Nueva España que resultó de la conquista de Manila en 1571 y la re-gularización del comercio Transpacífico -comúnmente conocido como
los galeones de Manila o las naos de China- entre las Filipinas y Acapulco.
En sus inicios, una oleada constante de inmigrantes asiáticos, mercancías y
nuevas técnicas de producción influyeron mesuradamente en la sociedad y
la economía colonial mediante un proceso que el autor denomina “Orientali-
zación”. No obstante, en ninguna manera “Orientalización” se debe equiparar
con el concepto de Edward Said de “Orientalismo” por la relación histórica,
única e intima de la Nueva España con Asia a principios de la edad Moderna.
Abstract
This article examines the totality of Asia’s influence on New Spain that resulted
from the conquest of Manila in 1571 and the regularization of transpacific tra-
de – more widely known as the Manila Galleons or naos de China – between the
Philippines and Acapulco. In its wake, a steady stream of Asian immigrants,
commodities, and manufacturing techniques measurably impacted colonial
society and economy through a process the author calls “Orientalization.”
However, “Orientalization” should in no way be equated with Edward Said’s
1. Artículo recibido el 28 de octubre de 2011 y dictaminado el 16 de noviembre de 2011.
2. Eastern Washington University.
98 México y la Cuenca del Pacífico. Año 15, núm. 43 / enero – abril de 2012
Edward R. Slack, Jr.
concept of “Orientalism” because of New Spain’s uniquely intimate historical
relationship with Asia in the early Modern era.
Introduction
Contrary to popular belief, the Philippines Islands were more a colony of New
Spain (Nueva España) than of “Old Spain” prior to the nineteenth century.
The Manila galleons, or naos de China (China ships), transported Asian pro-
ducts and peoples to Acapulco and other Mexican ports for approximately
250 years. Riding this ‘first wave’
of maritime contact between
the Americas and Asia were tra-
velers from China, Japan, the
Philippines, various kingdoms in
Southeast Asia and India known
collectively in New Spain as chinos
(Chinese) or indios chinos (Chine-
se Indians), as the word chino/a
became synonymous with the
Orient. The rather indiscrimi-
nate categorizing of everything
“Asian” under the Spanish noun
for the Ming/Qing empire, its
subjects and export items is easily
discovered in a variety of sources
from that age. To illustrate, the
eig hteenth centur y works of
Italian adventurer Gamelli Carreri and the criollo priest Joachin Antonio
de Basarás (who evangelized in Luzon) nonchalantly refer to the Philippine
Islands as “la China.”3 Additionally, words such as chinería (Chinese-esque,
European/Mexican imitation of Chines.
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
In this slide, we'll explore how to set up warehouses and locations in Odoo 17 Inventory. This will help us manage our stock effectively, track inventory levels, and streamline warehouse operations.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UP
Week #5-To Do List-CCHWeek 5 IntroductionIntroduction To Co.docx
1. Week #5-To Do List-CCH
Week 5: Introduction
Introduction To Compliance Documentation & Reporting
Proper documentation is an inherent component of delivery of
care, not an add-on. One of the oldest battles in healthcare is
that between the hospital Medical Records department and the
admitting Physician to complete necessary documentation for
the Patient’s Chart. The most common cause of loss of
admitting privileges has been from this source. This process
has only become more important and necessary with the
increasing recognition of the importance of proper
documentation for legal and ethical defense purposes.
Documentation also serves a number of financial aspects of
patient care delivery, including billing, grant writing for
research projects, medical research to discover future tests,
procedures, and cures, and funding for government supported
agencies and programs.
Objectives
To successfully complete this learning unit, you will be
expected to:
Identify the uses for health care documentation.
Learn the essential components of quality documentation.
Categorize the document guidelines under the federal False
Claims Act.
Identify the documentation required for compliance under the
Federal Stark Law.
List the aspects of documentation compliance with regard to
electronic health records.
Identify the important issues regarding ethical coding
practices.
Learn the most common illegal practices for HIM reporting.
Identify the key concerns under the federal False Claims Act
that relate to reporting.
2. Determine the impact of the Physician Quality Reporting
Initiative (PQRI) on HIM processes in physicians’ offices.
Identify the circumstances in which a health care
professional is mandated to report a patient’s diagnosis.
Week 5: Discussion
Answer the following questions:
Review the various uses for health care documentation and
discuss how each has an impact on the health care delivery
system
Discuss procedures you might enact in your facility to avoid
violating the False Claims Act
Discuss why physician offices should participate in PQRI
Week 5: Case Study Assignment
Please read and choose one of the following case studies:
Case study on page 111 of your textbook. (This Case Study is
in the section for Securing EHR and starts with "NOTE: In each
CMP (Civil Monetary Penalties) case resolved through a
settlement agreement, . . . ")
Case study on page 127 of your textbook. (This Case Study is
in the section for Phantom Patients and starts with "Two
Charged in False Claims to Medicaid."
Case study on page 128 of your textbook. (This Case Study is
in the section for Services not Performed and starts with
"WASHINGTON—April 14, 2008—A board-certified
radiologist, Fred Steinberg, M.D., his imaging centers . . ."
Case study on page 131 of your textbook. (This Case Study is
in the section for Upcoding and starts with "July 2007: In
Florida, a doctor was sentenced to 78 months in prison and
ordered to pay $504,000 . . . "
Case study on page 133 of your textbook. (This Case Study is
in the section for DRG Creep and starts with "In a report from
the Office of the Inspector General, with recommendations
3. regarding the evidence of upcoding DRGs by hospitals:"
Case study on page 134 of your textbook. (This Case Study is
in the section for Misuse of Modifiers 25 and 59 and starts with
" Findings: Forty percent of code pairs billed with Modifier 59
in FY 2003 did not meet program requirements, resulting in $59
million in improper payments."
Case study on page 135 of your textbook. (This Case Study is
in the section for Qui Tam and starts with "New Jersey Hospital
Company Settles Qui Tam Lawsuit Alleging Medicare Fraud for
$256 million."
Provide an explanation for the choice you made. Your paper
must address the following:
Address problem of the case decision.
A thorough analysis including resources.
Detailed comprehensive realistic recommendation.
Supplements with extensive compelling evidence from
legitimate sources.
Sources cited correctly in the body of the case and reference
page.
***PLEASECHOOSE ONE OF THE CASE STUDIES FROM
ABOVE SO THAT I CAN TYPE OUR FOR YOU FROM THE
TEXT***
Market Structure and Pricing Power
1
Market Structure and Pricing Power
2
4. Market Structure and Pricing Power
Hiara Custodio
University of Phoenix
Professor
5. Introduction
A Recent report by the Center for Disease Control showed
that 65 % of all Americans have a cover under the private
insurance. There are specific public programs that complement
the services provided by the private health industry. Public
programs include social insurance for the disabled, Medicare,
and Medicaid.
The federal government in conjunction with state governments
funds the programs. Private health insurance in the United
States forms a fundamental in the country`s health care
industry. Most Americans have taken medical cover under the
private insurance system.
Market Structure
An oligopoly is a distinct market structure where only a
few firms have overshadowed others and take a huge market
share. Very few firms dominate, though the market presence of
other small players may exist. The market, in this case, is
communally jointed to a few firms, and it is thus competitive.
For the case of United States, major health care insurances such
as Aetna and Anthem operate with minimal competition.
6. However, there are many smaller independent plans dedicated to
physically challenged people to offer specialty services. An
example of an insurance service that has dominated this market
is the Blue shield blue cross Permanente insurance plan.
The program evolved from Blue shield blue cross industrial
companies and was later on listed for public enrollment. It is
important to examine outcomes of different quality measures on
the demand for insurance products in the market.
Hypothetical analysis of the plan
The plan will use some variables as controls. The value of
this plan will increase as a number of people enrolled increases.
The program type variables are PPO and HMO, and both of
them offer broad networks. The two plans are relatively not
communicated within the consumer base, so many enrollees may
show less familiarity. Deductibles and out of pocket expenses
significantly limit changes. The variations have an influence on
demand. A deductible has to be paid before actual coverage,
hence high deductibles are much undesirable. Patients will
prefer plans that have some form of cost limit and have lower
deductibles. Research has shown that plans that have a
significant number of plan offerings will always hold better
value in the market.
Elasticity of the insurance offered
In estimating the elasticity of the insurance service, there
are several key approaches that researchers can adopt. The most
significant method is through the application of distinctions on
the premiums in a bid to identify the price consideration that
was taken into account. Alternatively, the researchers can use
distinctions in tax ratios over states as a means of recognizing
price elasticity in the insurance.
Most insurance plans contain many features that affect the
payment by consumers, and they may also undergo changes. The
out of pocket pay benefits are of particular importance in the
markets where minor beneficiaries are enrolled into zero-
7. premium plans. In this way, a large portion of the beneficiaries
income will be spent on the out of pocket pay.
The demand has shown that the out of pocket pay may
present particular importance in relation to the surplus. There is
a difference between the amount paid to different plans
countrywide. The government has a payment plan that gives
health maintenance organization (HMO) plans more pay than
the traditional Medicare. The PPO plan receives the highest
amongst the plans. The demand for insurance is elastic since an
increase in prices would lead to a decrease in number of
subscribers (McCanne, 2010). An example is when HMO plan
raises its prices. The effects are that they will lose customers
and subsequently lose on profit generation. Elastic demand has
helped shaped the industry and has motivated more firms to
reduce the price.
Marginal Cost and Marginal Revenue
Marginal revenue as a statistic is calculated by dividing
the difference in total revenue by the quantity change in output.
It is clear that the marginal revenue tends to remain steady over
a specific level of the production. The marginal revenue will
then follow the law of decreasing returns so that it shows delay
at some point. With increase in output, the health insurance
firms require an increase in fees charged. The perfectly
competitive companies will continue production until when the
marginal revenue will equal the marginal cost. In case the
marginal revenue exceeds the marginal cost, the HMO will have
an opportunity to increase profits by cutting the prices. The
lower prices will attract more subscribers and generate large
revenue.
Strategies for developing product differentiation and market
8. segmentation
Oligopolies have a definite advantage in the market and
maintain a large market share. Their level of dominance makes
it very costly for any rival wishing to capture their market
share. The market presents many barriers to new entrants. In
most cases, the incumbent in the market are continually
developing strategies that will keep out any invading
competition (Matthews, 2010). The insurance firms in this
market can adopt a non-price strategy.
It is the most convenient since price competition will form a
very destructive force. They will only have to seek consumer
interest through sales promotions or offering low premiums.
Loyalty schemes are an alternative non-pricing strategy in the
insurance sector.
Alteration of fixed and variable cost to support the strategy
Mixed costs refer to costs that are directly connected to the
product, and it has to be paid regardless of the amount sold. As
for the fixed cost, they must be paid at the end of every month.
In cases where consumers fail to purchase insurance plans, the
company will still have to pay the physicians and staff. Variable
costs changes with the amount of sold. The strategy will
incorporate the variable cost factor by increasing plan premiums
when consumers purchase more plans. Variable costs relate to
materials and labor, which fluctuates with time.
9. Conclusion
Oligopolies have a tendency to implement very
competitive approaches. There is a trend towards designing
their strategies in ways that create advantages that are present
in the more competitive market structures. Due to the fact that
there are very few number of companies operating in the
market, the firms have to implement marketing techniques that
bring higher competitiveness. Oligopolists have shown
dominance in the innovation of new products (Sonnenholzner,
2006).
The super profits they generate are useful in revolutionizing the
sector, hence improved performance. Application of the
described models will result in economic stability of the sector.
Price stability will further benefit the consumers since they can
easily plan ahead. Consumers that have a well-laid out plan
have increased chances of controlling their expenses, which will
increase the probability of them subscribing to insurance
policies. Approaches that focus on the consumers will increase
the number of subscribers and subsequently benefit the entire
health insurance industry.
10. References
Investopedia. (n.d.). Oligopoly Definition | Investopedia.
Retrieved April 18, 2016, from
http://www.investopedia.com/terms/o/oligopoly.asp
Matthews, M. (2010, June 7). America's Coming Health Care
Oligopoly. Retrieved April 18, 2016, from
http://www.forbes.com/2010/07/07/healthcare-reform-
insurance-hospitals-contributors-merrill-matthews-
obamacare.html
McCanne, D. (2010, June 25). The private insurance oligopoly -
PNHP's Official Blog. Retrieved April 18, 2016, from
http://pnhp.org/blog/2010/06/25/the-private-insurance-
oligopoly/
Sonnenholzner, M. (2006, September 13). Oligopoly in
Insurance Markets - Encyclopedia of Actuarial Science -
Sonnenholzner - Wiley Online Library. Retrieved April 18,
2016, from
http://onlinelibrary.wiley.com/doi/10.1002/9780470012505.tao0
03/abstract
MHCM 6320 Corporate Compliance and Legal Issues in
Healthcare
Chapter 6 Compliance Documentation
Chapter 7 Compliance Reporting
Week 5 Lecture Notes
11. It is important that the compliance program highlight this
requirement for adequate
documentation of all aspects of patient care delivery. The
documentation serves a
number of valuable purposes, besides the requirements of
compliance. Specifically, it
provides support for medical decision making, provides for
continuity of patient care,
supports patient and public safety, assists in the allocation of
resources, supports
research and education, and finally provides evidence of
compliance. Good
documentation also contributes to quality improvement
programs and supplies
necessary information to proper payment/reimbursement.
In order for documentation to serve all of these aspects of
patient care well, it must be
complete, accurate, timely and accessible. It should always be
signed or otherwise
confirmed.
A growing practice that presents considerable danger in any
documentation is the
12. practice of excessive abbreviations or use of mnemonics,
acronyms, symbols or other
shortcuts in word usage. This is a dangerous practice
throughout our culture,
aggravated by the use of texting and email as well as the
generally sloppy use of
language. No abbreviation should be used in a document
without first using the full
word or phrase to be represented by the shortened version.
Unfortunately, many
abbreviations have “twins” with totally different meanings, and
this can lead to
misunderstanding at the least and disaster at the greatest. This
problem has reached
the point that some organizations have published “Do Not Use”
lists of such
abbreviations.
The False Claims Act sets out specific elements for
documentation compliance.
According to the Act, patient records must be complete and
specific with regard to
medical necessity, certification of medical necessity, refunding
of overpayments,
13. contractual agreements with billing service companies, release
of information regarding
reimbursement, diagnostic X-Ray interpretation, certification of
compliance, dates of
service, and claims support.
The Federal Stark Law, which is reinforced or expanded by
many state laws, forbids a
referring physician from financial gain when referring a patient
to another physician –
usually a specialist, when the patient is a Medicare or Medicaid
beneficiary. This rule is
applied across a broad spectrum of referral situations and is not
restricted to only
physician to physician referrals, but includes referrals to
organizations or companies in
which the referring physician may hold an interest and therefore
benefit from the
revenue or any other benefit generated from the referral.
There is also federal legislation known as the Federal Anti-
Kickback Statute that makes
14. it a crime to exchange any type of benefit for a referral. This is
broader than the Stark
Law in that no involvement of Medicare or Medicaid is required
to be in violation.
There are certain required elements of documentation for
physicians in every patient
encounter. These elements must always be present: the date;
the patient identity; a
unique identifier for the patient; the identity of the provider; the
reason for the encounter;
details of all communications; details of any examination/s;
objective findings; complete
description of all services performed; follow-up orders;
provider’s signature.
Hospitals have an additional set of documentation requirements,
and these were
expanded in 2007 when the CMS mandated that hospitals report
those conditions
identified for each patient that were present at the time of
admission. There are also
specific requirements for documentation of physician’s notes in
the patient’s record.
15. Electronic Health Records (EHR) are finally becoming a reality.
Your instructor was
President of one of the three first companies in the United
States to develop total
hospital information systems (THIS), in the late 1960s-
specifically beginning in 1967. It
was an element of these early systems to produce an electronic
patient record as a by-
product of the use of these computer driven communication and
data collection systems
by capturing the medical information at the source and
processing it and recording it to
the finish. Unfortunately, the road has been very long and
frustrating and fraught with
not only technological difficulties but with patient care
deliverers resistance to change.
In 2004, President George W. Bush set a goal for
implementation of the electronic
health record by 2014. While that goal too has failed to be met,
progress has now been
great and the end result is definitely in sight.
As the dream becomes a reality, it is vital that the compliance
officer work with the
16. technology department to ensure that such a record be kept
secure. It is necessary to
assure the identity of everyone working with and having access
to this record, and that
their integrity and honesty be thoroughly researched and clear.
Next, assure that
access to the records is also protected through the use of a
strong password that is
unique and used only for accessing these records. The make
certain that access to the
data is restricted to only those having a legitimate need.
Also be certain that the technology provides for authentication
by only the proper
authorities, and that an audit trail of access to the records is
created and maintained.
Clinical laboratory records are the subject of special regulations
under the Clinical
Laboratory Improvement Amendments (CLIA) wherever the
tests are performed
Even such things as notices to patients of their rights to speak
on their own behalf have
17. become the subject of regulations of information. Medicare has
such a requirement in
its form “An important Message from Medicare About Your
Rights”. This form notifies
patients of their right to question the timing of their release
from hospital care if it is felt
that they are being released too early to reduce billing.
Health care facilities are required by the U. S. Government to
retain patient records for
ten years, in most cases. Other governmental agencies and
payer or accreditation
organizations may have added requirements.
Upon expiration of the required retention period/s, there are
additional requirements
regarding the disposal/destruction of these records.
Coding of medical information preceded the introduction of
automation/computerization
in healthcare information processing, but the rather thorough
permeation of the
processing of healthcare information through computer
technology has increased the
18. speed and comprehensiveness of this activity. Coding simply is
the conversion of
words and phrases into unique sets of numbers so that the
processing of the
information may be more efficient and effective.
The first two major coding systems to become familiar with is
the International
Classification of Diseases (ICD) – Clinical Modification,
currently in its 9th edition,
therefore ICD – 9 – CM, and Current Procedural Terminology
(CPT). It is vital that only
valid, accurate data is passed to the agencies and third-party
payers who rely on this
information. To this end, the American Health Information
Management Association
(AHIMA) publishes Standards for Ethical Coding.
The most common areas of concern in accurate reporting
include the place of service
codes, duplicate billing, unbundling, phantom patients,
“incident to” services, services
not performed, and balance billing. Each of these areas are
more fully discussed in the
19. Textbook and should be studied in detail.
A new code, created on January 23, 2004, by the action of the
Secretary of the
Department of Health and Human Services, known as the
National Provider Identifier
(NPI) replaces all previous provider identifiers, including the
UPIN. This code is free for
the asking and is to be used for all claims forms used in billing
for physician and
outpatient services as well as for inpatient hospital claims.
Coders and billers are responsible under the law, not only the
Federal False Claims Act
but state and other counterparts to it, for filing claims that
contain false information if
they “know or should have known” that the information filed
was false. Ignorance of the
law is NO EXCUSE. Numerous examples of this are given in
the textbook in Chapter 7.
A number of other coding systems are in use and must be
20. recognized in carrying out
required compliance reporting. The Physician Quality Reporting
Initiative (PQRI) is a
voluntary reporting system that uses Category II codes. These
Category II codes are
separate from: Category I codes – or Regular CPT codes and
Category III Codes –
Emerging technology codes or HCPCS, Level II codes – for
ancillary services such as
durable medical equipment and medical supplies.
States vary as to the mandatory reporting requirements with
respect to domestic
violence, abuse and neglect, but most require physicians,
osteopaths, chiropractors,
nurses, health personnel engaged in the admission, examination
and care or treatment
of children, health professionals, and mental health
professionals, among others.
Likewise, in the case of communicable diseases, there is broad
legal and ethical
requirements placed on health care providers to report
contagious or communicable
21. symptoms that may lead to epidemics or pandemics.
MHCM 6320 Corporate Compliance and Legal Issues in
Healthcare
Chapter 6 Compliance Documentation
Chapter 7 Compliance Reporting
Week 5 Lecture Notes
It is important that the compliance program highlight this
requirement for adequate
documentation of all aspects of patient care delivery. The
documentation serves a
number of valuable purposes, besides the requirements of
compliance. Specifically, it
provides support for medical decision making, provides for
continuity of patient care,
supports patient and public safety, assists in the allocation of
resources, supports
research and education, and finally provides evidence of
compliance. Good
22. documentation also contributes to quality improvement
programs and supplies
necessary information to proper payment/reimbursement.
In order for documentation to serve all of these aspects of
patient care well, it must be
complete, accurate, timely and accessible. It should always be
signed or otherwise
confirmed.
A growing practice that presents considerable danger in any
documentation is the
practice of excessive abbreviations or use of mnemonics,
acronyms, symbols or other
shortcuts in word usage. This is a dangerous practice
throughout our culture,
aggravated by the use of texting and email as well as the
generally sloppy use of
language. No abbreviation should be used in a document
without first using the full
word or phrase to be represented by the shortened version.
Unfortunately, many
abbreviations have “twins” with totally different meanings, and
this can lead to
23. misunderstanding at the least and disaster at the greatest. This
problem has reached
the point that some organizations have published “Do Not Use”
lists of such
abbreviations.
The False Claims Act sets out specific elements for
documentation compliance.
According to the Act, patient records must be complete and
specific with regard to
medical necessity, certification of medical necessity, refunding
of overpayments,
contractual agreements with billing service companies, release
of information regarding
reimbursement, diagnostic X-Ray interpretation, certification of
compliance, dates of
service, and claims support.
The Federal Stark Law, which is reinforced or expanded by
many state laws, forbids a
referring physician from financial gain when referring a patient
to another physician –
usually a specialist, when the patient is a Medicare or Medicaid
beneficiary. This rule is
24. applied across a broad spectrum of referral situations and is not
restricted to only
physician to physician referrals, but includes referrals to
organizations or companies in
which the referring physician may hold an interest and therefore
benefit from the
revenue or any other benefit generated from the referral.
There is also federal legislation known as the Federal Anti-
Kickback Statute that makes
it a crime to exchange any type of benefit for a referral. This is
broader than the Stark
Law in that no involvement of Medicare or Medicaid is required
to be in violation.
There are certain required elements of documentation for
physicians in every patient
encounter. These elements must always be present: the date;
the patient identity; a
unique identifier for the patient; the identity of the provider; the
reason for the encounter;
details of all communications; details of any examination/s;
objective findings; complete
25. description of all services performed; follow-up orders;
provider’s signature.
Hospitals have an additional set of documentation requirements,
and these were
expanded in 2007 when the CMS mandated that hospitals report
those conditions
identified for each patient that were present at the time of
admission. There are also
specific requirements for documentation of physician’s notes in
the patient’s record.
Electronic Health Records (EHR) are finally becoming a reality.
Your instructor was
President of one of the three first companies in the United
States to develop total
hospital information systems (THIS), in the late 1960s-
specifically beginning in 1967. It
was an element of these early systems to produce an electronic
patient record as a by-
product of the use of these computer driven communication and
data collection systems
by capturing the medical information at the source and
processing it and recording it to
the finish. Unfortunately, the road has been very long and
26. frustrating and fraught with
not only technological difficulties but with patient care
deliverers resistance to change.
In 2004, President George W. Bush set a goal for
implementation of the electronic
health record by 2014. While that goal too has failed to be met,
progress has now been
great and the end result is definitely in sight.
As the dream becomes a reality, it is vital that the compliance
officer work with the
technology department to ensure that such a record be kept
secure. It is necessary to
assure the identity of everyone working with and having access
to this record, and that
their integrity and honesty be thoroughly researched and clear.
Next, assure that
access to the records is also protected through the use of a
strong password that is
unique and used only for accessing these records. The make
certain that access to the
data is restricted to only those having a legitimate need.
Also be certain that the technology provides for authentication
by only the proper
27. authorities, and that an audit trail of access to the records is
created and maintained.
Clinical laboratory records are the subject of special regulations
under the Clinical
Laboratory Improvement Amendments (CLIA) wherever the
tests are performed
Even such things as notices to patients of their rights to speak
on their own behalf have
become the subject of regulations of information. Medicare has
such a requirement in
its form “An important Message from Medicare About Your
Rights”. This form notifies
patients of their right to question the timing of their release
from hospital care if it is felt
that they are being released too early to reduce billing.
Health care facilities are required by the U. S. Government to
retain patient records for
ten years, in most cases. Other governmental agencies and
payer or accreditation
28. organizations may have added requirements.
Upon expiration of the required retention period/s, there are
additional requirements
regarding the disposal/destruction of these records.
Coding of medical information preceded the introduction of
automation/computerization
in healthcare information processing, but the rather thorough
permeation of the
processing of healthcare information through computer
technology has increased the
speed and comprehensiveness of this activity. Coding simply is
the conversion of
words and phrases into unique sets of numbers so that the
processing of the
information may be more efficient and effective.
The first two major coding systems to become familiar with is
the International
Classification of Diseases (ICD) – Clinical Modification,
currently in its 9th edition,
therefore ICD – 9 – CM, and Current Procedural Terminology
(CPT). It is vital that only
29. valid, accurate data is passed to the agencies and third-party
payers who rely on this
information. To this end, the American Health Information
Management Association
(AHIMA) publishes Standards for Ethical Coding.
The most common areas of concern in accurate reporting
include the place of service
codes, duplicate billing, unbundling, phantom patients,
“incident to” services, services
not performed, and balance billing. Each of these areas are
more fully discussed in the
Textbook and should be studied in detail.
A new code, created on January 23, 2004, by the action of the
Secretary of the
Department of Health and Human Services, known as the
National Provider Identifier
(NPI) replaces all previous provider identifiers, including the
UPIN. This code is free for
the asking and is to be used for all claims forms used in billing
for physician and
outpatient services as well as for inpatient hospital claims.
30. Coders and billers are responsible under the law, not only the
Federal False Claims Act
but state and other counterparts to it, for filing claims that
contain false information if
they “know or should have known” that the information filed
was false. Ignorance of the
law is NO EXCUSE. Numerous examples of this are given in
the textbook in Chapter 7.
A number of other coding systems are in use and must be
recognized in carrying out
required compliance reporting. The Physician Quality Reporting
Initiative (PQRI) is a
voluntary reporting system that uses Category II codes. These
Category II codes are
separate from: Category I codes – or Regular CPT codes and
Category III Codes –
Emerging technology codes or HCPCS, Level II codes – for
ancillary services such as
durable medical equipment and medical supplies.
States vary as to the mandatory reporting requirements with
respect to domestic
31. violence, abuse and neglect, but most require physicians,
osteopaths, chiropractors,
nurses, health personnel engaged in the admission, examination
and care or treatment
of children, health professionals, and mental health
professionals, among others.
Likewise, in the case of communicable diseases, there is broad
legal and ethical
requirements placed on health care providers to report
contagious or communicable
symptoms that may lead to epidemics or pandemics.