Cchc Case Study Summary

HCPCs is a collection of codes that represents the procedures, supplies, products, and services that may be provided to Medicare and Medicaid and to individuals enrolled in private health insurance programs. HCPCs are necessary for Medicare and Medicaid providers to provide healthcare claims that are managed consistently to get payment. Some of the settings you would use HCPCs codes would be in home healthcare, laboratory services, and dentist.

Currently, the NE LHIN distributes their budget to flow to 64% hospitals that are located in the northeastern Ontario, 15% to long-term care, 14% to home and community care providers and 6% to community mental health and addiction providers and 1% to community health providers (NE LHIN, 2014). The North East LHIN community revealed that their

Responsible for all aspects of the credentialing, re -credentialing and contracting for all medical providers and dental providers who give patient care at the HHD Clinics. Responsible for ensuring medical providers, dental providers, clinics, and programs have been enrolled with health plans and linked to all clinics. Keep data for each provider, clinic, and program to ensure prompt renewal of licenses and certifications. Start the contract process for HHD and potential payers by acting as liaison for HHD and medical payers to ensure contracts are generated for the City of Houston Legal team to review. Also, ensure all services that are given by HHD claims are filed in a prompt matter, follow up and identify any trends for payment to be

MHC Healthcare (MHC) is a community health center located in Marana, Arizona. MHC Healthcare originally opened in 1957 as Marana Health Center. MCH started out in a small building and continued to thrive over the years. Through the years, MHC expanded to 13 sites all across Pima County, Arizona. In 2011, MHC opened Marana Main Health Center, a new 74,000 square foot community health center (CHC) in Marana. Marana Health Main Center is a full service facility including Quick Care, Family Practice, Internal Medicine, Integrated Healthcare Center (IHCC), Pediatrics, Obstetrics & Gynecology and Dental Services. The Center also provides Pharmacy, Laboratory and Radiology services, along with Women’s Infants and Children (WIC) services.

Finally, the last problem identified is the need for HCCH to widen its scope.  If HCCH applied for a federal change in scope, from a health care facility for the homeless to one addressing community wide needs, this would allow HCCH to report this full client base to the government for increased funding.

The purpose of HCPCS is to provide information about what procedures, supplies, services, and products that were provided from either Medicare, Medicaid and private insurance programs. They are necessary because Medicare and Medicaid require the use of HCPCS for claims submission to receive payment. National codes are not used by inpatient healthcare facilities when reporting the services provided. The type of settings you would use HCPCS codes would be long-term care facilities, transportation services such as ambulances, and a rehab for drug addiction or behavioral health.

HCAHPS survey is a patient satisfaction survey required by CMS (The Centers for Medicare and Medicaid Service for all hospitals in the United States. HCAHPS identified the attributes of affective support, health information, and quick response as the elements of nursing care in the interaction and relationship between patient and nurse that determine patient satisfaction. High score of these elements would increase the hospital competition.

For instance, patients will receive urgent hospital care and then will not be able to pay back their bills. Another policy affecting provider reimbursements is the change from volume-based care to value-based care. For instance, the Centers of Medicare and Medicaid (CMS) have mandatory reporting guidelines that all healthcare providers have to participate in. These reports were based off volume of care (fee-for service) for the past 9 years, but due to the high costs in healthcare, the CMS is changing over to a valued based care (pay-for

Your post was well-written, clear, and thoughtfully addressed the concepts of HCZ in the case study. In reading your post, there was one of the commonalities that was similar to my discussion post such as the economic status. I support your statement about Canada's childhood dream became a reality. Indeed, his theory to save thousands of children became a support system for many people as mentioned in the case study. According to Grossman and Curran (2004), "Canada felt that to reach thousands of poor children in Harlem...setting up a seamless system of support from the moment of pregnancy to the time that child goes to college" would be the best practice of service delivery (p.1). In other words, Canada's goal was to change the children

As the shift for HCOs is made to a PCMH model, the financial aspect also has to make a transition to accommodate to the changes. In recent years, there have been implementations of different payment and reimbursement options, health insurance programs, and the establishment of the Affordable Care Act (ACA). Between May 2009 and April 2012, one of the initial PCMH pilot programs was conducted in Colorado, appropriately named The Colorado Multipayer Patient-Centered Medical Home Pilot. More than 100,000 patients within sixteen internal medicine practices participated in the experimental PCMH model, using six different health plans (Harbrecht & Latts, 2012).

Self-care and medical consumerism programs are also a part of DM. They provide member with access to medical information that will assist them in caring for themselves and knowing when to consult a professional. These programs are now an accreditation standard for health plans by the National Committee for Quality Assurance (NCQA) as they promote consumer directed health (CDH). The benefits of self-care programs show $2.50 to $3.50 saved for every $1 invested by health plans. A HMO study done showed a decrease in outpatient visits as well as a 2:1 return (Kongstvedt, 2007, p.192). Another different study showed a decrease in pediatric acute care visits also.

Data collection can be subdivided into three categories with service type, department, and floor. This collection of data is valuable tool that managers need to have in order to understand the flow of business within each department. With the collection of data it will allow managers to calculate the volumes of patients during specific times.

For patients with chronic conditions, costs, even with insurance, can add up very quickly with numerous doctor’s visits, emergency room visits, and hospital admissions. The CDC (2016), states, “Treating people with chronic diseases accounts for 86% of the nation’s health care costs” (Center of Disease Control and Prevention, 2016). Despite the amount of time and money spent preventing and treating

Columbus Regional Hospital (CRH), a non-for-profit organization with 225 beds, is the system’s star facility (Columbus Regional Health, n.d.). CRH has a Privacy Excellence Award, and the National Committee for Quality Assurance recognized CRH for outstanding patient-centered medical home practices (Columbus Regional Health, n.d.). Additionally, the Becker’s Hospital Review named CRH as a great community hospital, and Thomson Reuters acknowledged CRH in the top 100 hospitals (Columbus Regional Health, n.d.). Moreover, CRH is one of the most beautiful hospitals in America (Columbus Regional Health, n.d.). They provide emergency and surgical services and comprehensive care in many specialty areas, such as, mental health (Columbus Regional Health, n.d.).

With the population of adults 65 and over steadily climbing, medical professionals and the healthcare system are struggling to keep up. One major issue concerning the healthcare system is that it is not set up properly provide care for these older adults. The physicians today, who regularly see patients, focus mainly has been; diagnose—usually in a 15-20 minute office visit, treat, and cure. Many of these senior citizens have multiple chronic illnesses or diseases, which require time to manage and treat. The problem is that they may not be able to explain what the real problem to a doctor in that time.