In week 5, I will discuss what prospective payment system (PPS) is and the history. I will also be discussing the challenges and success areas of PPS. I will be using my own life example to explain how PPS might work in real life. In my conclusion, I will be going over what I discovered, the history of PPS and the challenges and success areas. Prospective payment system (PPS) is a type of reimbursement method to reduce cost and based on a fixed amount, which is predetermined (CMS, 2015). There are separate PPSs for reimbursement to acute inpatient hospitals, home health agencies, hospice, hospital outpatient, inpatient psychiatric facilities, inpatient rehabilitation facilities, long-term care hospitals, and skilled nursing facilities, according to CMS.gov. Medicare has implemented a PPS for each PAC setting (Casto, 2013, p. 213). After this process, the inpatient PPS in October 1983, Medicare expenses in PAC grew at a “tremendous” rate (Cotterill and Gage 2002, 1) (Casto, 2013, p. 213). So, congress took action to slow down this tremendous process of accruing expenses (Casto, 2013, p. 213). According to our textbook, between 1998 and 2002, there were federal …show more content…
It would be obvious to place patients in the same areas as their diagnosis or sickness. They would also use the same types of resources needed for their illness. For example, I was in the hospital for the delivery of my son. The hospital would only allow me to stay for less than a week and then I was put on “sleeper’s status,” which means I was discharged, but because my son had health issues I was allowed to stay 24 hours after my discharge. I was also transferred to the pediatrics ward, so my son could receive one more treatment of phototherapy. So, because I was not sick, but my son was, I was able to stay and nurse
Phase I addressed basic statutory definitions, general prohibitions, and explanations of what constitutes a financial relationship between a physician and a health care entities providing DHS’. Phase II deals with the regulatory exceptions, reporting requirements, and public comments pertaining to Phase I. Finally, Phase III Final Regulations were published in September of 2007, and largely addressed comments made after publication of the Phase II rules and regulations. It also reduced some of the regulations placed upon the healthcare industry by explaining and modifying some of the exceptions related to financial relationships between physicians and DHS entities where there is minimal risk of abuse to the patient, Medicare or Medicaid.
In nursing, the patient is often viewed as the main priority of the nursing staff. The nurse works to provide care for the patient based on the patient 's admitting diagnosis. However, the patient must be looked at as a part of the greater system they exist in such as their family or home environment. While the patient may be ill due to a bacterial infection or virus, their family environment also plays a role in their overall health and wellness.
spiritual that was talked about. I think that if the nurse's and the patients had a
Area I have selected for the field is Long-Term Acute Care Hospital (LTACH) specializing in pediatrics. Long-Term Acute Care Hospital, specializes in treatment for special needs such as patients with concurrent acute illnesses, recovering from acute illness due to multisystem failures, requires direct care by multiple specialists, ventilator services (weaning or decannulation), needing of daily physician visits or have complex respiratory-relevant diagnoses. Which in terms focuses on patients who have complex medical problems and the rehabilitation needs that one may require special or intensive treatment over an extended period of time. Patients who come to LTACH have been in an ICU or CCU at a hospital and now require specialized care (as
The method that I had stated previously leads to better outcomes because it decreases the amount of hospital readmissions. This is because patients that come to the ED have a slight chance of having their issues resolved. By placing a person at the homes of the patient to provide consistent care for them, their conditions can be monitored and assessed based on their symptoms if they develop. If some symptoms develop that the healthcare provider can solve, than that is one case of a hospital readmission avoided. This could also potentially reduce the costs incurred
The private insurers are patients with other insurances. Under Medicare and Medicaid, services that are provided by the hospitals are paid by a prospective reimbursement. Prospective reimbursement is established before the services are provided. They have a defined dollar amount per day and per diagnosis. They also use a fee scheduled by CPT code or procedure code which is usually used for physicians. Since these types of insured patients only are billed a certain amount, most procedures are not fully reimbursed. Retrospective reimbursement is determined after the services have been delivered. This is one of the reasons organizations are struggling. Along with less reimbursement, the CPT codes or procedure codes have to be correct according to the procedure ordered. “If an organization wants to get paid, its better off taking the time to make sure all its codes are accurate, timely , and meet all payers’ requirements ”(Kapsambelis, 2004, p. 3).
outside of the ward. Instead, the information is used to keep the patients under her complete
Medicare uses the Medicare Physician Fee Schedule to pay physicians and the Outpatient Prospective Payment System to pay hospitals and other outpatient facilities. Recently, the Centers for Medicaid and Medicare Services (CMS) made changes to physician and outpatient payments. The five levels clinic visit codes or five outpatient codes were replaced with a single code. “The Chronic Care Management Fee will go into effect in January 2014 and will be the new form of physician compensation. Bundle Payment is a way for paying for high volume, high cost hospital procedures. Global payment enables providers to reduce unnecessary care and bring down spending under control but creates incentives for providers to restrain the supply of services.
I believe people are connected beings with fundamental pride and values. To appropriately care for a person, the patient must be considered as a whole package. In order to do this, the person’s physical, social, psychological, cultural, spiritual, and aspects of their life must be considered when creating a plan of care. Environment can be defined as “the aggregate of surrounding things, conditions, or influences; surrounding and the social and cultural forces that shape the life of a person or a population,” (n.d.). A person’s environment is such a large part of their life and such an influencing factor on their day-to-day decisions. Their environment includes their socio-economic status (can they afford their prescriptions? Is the test that’s being run really necessary or an undue burden on them financially?), demographics (what is their understanding of health? What are their religious beliefs? what are their race/are they more susceptible to certain conditions?), access of to health care (do they drive/have transportation? Do they have health insurance?), and social support (are they alone? Do they have too much support with too many opinions?). As a nurse, one must always know a person is in continuous contact with their environment and the stress that come along with it. An appropriate and relaxing environment can impact a patient’s adherence to their medications and treatments and reduce their recovery time. The third concept on which I based my philosophy is health, which is the absence of illness. As a nurse and/or practitioner, it is important to focus on the patient’s main health complaint as well as any associated symptoms, needs, and overall wellness of the patient. Nursing is the promotion, deterrence of sickness and harm, protection, optimization of wellbeing and abilities; and advocacy in the care of individuals, populations, communities,
In 1983, the Medicare prospective payment program was implemented, which allowed hospitals to be reimbursed a set payment based on the patient’s diagnosis, or Diagnosis Related Groups (DRG), regardless of what treatment was provided or how long the patient was hospitalized (Jacob & Cherry, 2007).... ... middle of paper ... ... Case Management Related to Other Nursing Care Delivery Models.
Global Payments Inc is payment-processing service that serves as a middleman between the merchant and the bank to make sure that the transaction goes through. In March of 2012, Global Payments recognized a data breach in its security system after a blogger displayed a hack in the company. Paul Garcia, CEO at Global Payments at the time of the breach reassured the public that the breach was small and that it was intercept internally. A few times after the expansion of the news, three separate card-issuing institutions came forward with proof that Visa and MasterCard was confirming the breach, and that it occurred earlier that year between January 21 and February 25. After investigation, in April, Visa reissued a statement claiming that the
Beside digital service payments for physical goods are also possible, both at selling and ticketing machines, and at operated Point-of-Sale terminals. Typical usage needs the user electing to make a mobile payment, being connected to a server via the mobile device to perform authentication and authorization, and subsequently being presented with confirmation of the completed transaction ( Turowski, & Pousttchi,2004)
payment. PayPal is also available to people in 38 countries. This paper starts with introduction to the company and its services. The
A cashless society will further improve the globalisation that characterise our present time. The computerised systems can be used to decrease the quantity of paper trail therefore substituting paper cash with cashless credits or electronic money transfers. However, in a cashless economy, this will change with certain crimes almost eradicated. It will also be faster to generate electronic payments than cash as Near Field Communications (NFC) chips make their way into more payments cards and mobile handsets as well providing protection not applicable to purchases made using cash. This technology is simple with low power wireless link evolved from radio-frequency identification (RFID) tech that can transfer small amounts of data between two devices identifying us and our bank account to a computer. Another benefit of drawing nearer to a cashless society is that other companies are providing pioneering cash-free solutions to the payment related problems we come across. For example, WisePay, a provider of e-payments services, is deploying technologies that ensure parents no longer have to worry about sending their children to school with cash to pay for meals, excursions and other fees that will eliminate the likelihood of being caught short for cash or children misplacing money. The Government also has valuable explanations why they may deem to turn away from cash. Due the main factor of printing and distributing cash, not to mention ensuring the economy is free from forgeries which are all costly endeavours estimating that the cost to society of using cash is between 0.5 and 1.5% of GDP annually. In addition, there are many technological innovations that propose there is a real enthusiasm for an alternative to cash with the upsurge...
Hospitals play an important role in the health care system (Hospitals, n.d.). They are health care institutions that have an organized medical and other professional staff, and inpatient facilities, and deliver medical, nursing and related services 24 hours per day, 7 days per week. Hospitals offer a varying range of acute, convalescent and terminal care using diagnostic and curative services in response to acute and chronic conditions arising from diseases as well as injuries and genetic anomalies. In doing so they generate essential information for research, education and management. Traditionally oriented on individual care, hospitals are increasingly forging closer links with other parts of the health sector and communities in an effort