respond to each classmate in atleast 450 words using atleast 2 schoolarly sources and 1 biblical refrerence. Current apa format.
respond to #1-
The Timeline of the ACA and the Influence that it has on the Quality of Care that is delivered to the Beneficiary
The history of the Patient Protection and Affordable Care Act (PPACA) which is commonly referred to as the Affordable Care Act (ACA) was signed into law by President Obama on March 23, 2010. This law “was designed to ensure that all Americans have access to quality health care that is affordable and that will ultimately reduce healthcare costs, which have been on the rise over the years”(Harrington, 2016, p. 93).All new health plans were required to cover specified preventive screening services for adults without any added out-of-pocket charges. ACA provisions implemented in 2010 that affect government-sponsored insurance included federal matching funds to allow states to expand Medicaid funding to reach more low income individuals and families (Healthcare.gov, 2016).In 2012, an effort to provide voluntary options for long-term care for disabled Americans was put on hold. Although the Supreme Court upheld the ACA in June 2012, states were allowed the option to participate in Medicaid expansions and it was here that the value-based purchasing (VBP) program was established for traditional Medicare, offering financial incentives to hospitals in order to improve the quality of care to patients (Healthcare.gov, 2016).In 2013, the open enrollment in the healthcare marketplace began. Here, the ACA made funding available to the states covering preventive care under Medicaid at little or no cost to the beneficiary (Healthcare.gov, 2016).In 2014, health care plans were prohibited from discriminating against individuals with pre-existing conditions or refusing these individuals coverage based on their pre-existing conditions or gender (Healthcare.gov, 2016). In 2015, Centers of Medicare and Medicaid Services (CMS) adjusted physician payments so that they can provide value-based incentives for quality care (Healthcare.gov, 2016).
Although several attempts have been made to repeal the ACA, and multiple court cases have been filed, the passage of the ACA has had a significant effect on healthcare access and delivery and the Bible is not silent on rendering care to everyone as we see that the Lord cares for everyone and commands us to care for the sick and needy in the society as seen in the bible when Jesus said: “Heal the sick, cleanse the lepers, raise the dead, cast out devils: freely ye have received, freely give” (Matthew 10:8, King James Version).
The Process for Filing an Appeal for Healthcare-Related Services that are Denied by the Insurance Company.
The process of filing an appeal for any kind of claim requires lots of time and effort to be put into it and filing an appeal for healthcare related services is not different because it also requires a considerable amount of time and effort and once a patient’s payment for healthcare-related services are denied, the patient will have to appeal the decision in writing and state why he or she does not agree with the decision of the insurance company and the insurance company will then review the appeal and make their own decision if they are going to deny or grant an appeal. If the appeal is denied, the insurance company must notify the patient in writing the reason for the denial and inform them that they have a right to request for an external reviewer (Harrington, 2016) who is licensed in the same or similar specialty as your treatment.
Harrington, M. K. (2016). Health care finance and the mechanics of insurance and reimbursement. Burlington, MA: Jones & Bartlett Learning.
Health Plan Information 2016. (n.d.). Retrieved from https://www.healthcare.gov/health-plan-information…
The King James Study Bible: King James Version. (2008). Nashville: Thomas Nelson
RESPOND TO #2-
The Affordable Care Act (ACA) has been known as a game changer in the world of health care. Through new policies and insurance programs, it was established to make sure that all Americans have access to health care (Harrington, 2016). One of the main goals of the ACA to help patients receive quality care that is at a reasonable cost that individuals can afford (Harrington, 2016). Starting at the beginning in 2010, the ACA looks at ways that the government can use the ACA to help prohibit insurance companies from denying coverage to children under the age of 19 due to a pre-existing condition (Harrington, 2016). Another improvement that the ACA provided was allowing consumers to compare coverage plans online (Harrington, 2016). This allowed more flexibility to take time to look each individual plan and decide what best plan was for an individual or family based on their needs (Harrington, 2016). In 2011, the ACA was focusing its efforts on improving quality of care by providing multiple incentives (Harrington, 2016). These incentives include prescription drug discounts, free preventative care for the elderly, increased access to home care, and focusing on the Accountability of Insurance Companies (Harrington, 2016).
In 2012, there was progress in improving the quality of health care and now efforts are focused on lowering those costs to a reasonable level (Harrington, 2016). Value-based purchasing (VBP), was developed for the Accountable Care Organizations (ACO) to collect and report clinical data to improve and better coordinate patient care (Harrington, 2016). VBP is a Centers for Medicare and Medicaid Services (CMS) initiative that rewards acute-care hospitals with incentive payments for the quality care provided to Medicare beneficiaries (Center for Medicare and Medicaid Services, 2017). Section 1886(o) of the Social Security Act establishes the Hospital VBP Program, and CMS rewards hospitals based on the quality of care provided to Medicare patients, how closely best clinical practices are followed, how well hospitals enhance patients’ experiences of care during hospital stays, and hospitals are no longer paid solely on the number of services provided (Center for Medicare and Medicaid Services, 2017).
Under the Hospital VBP Program, Medicare makes incentive payments to hospitals based on either: How well they perform on each measure compared to other hospitals’ performance during a baseline period, how much they improve their performance on each measure compared to their performance during a baseline period (Center for Medicare and Medicaid Services, 2017). The CMS calculate and use performance scores from the Hospital Consumer Assessment of Health care Providers and Systems (HCAHPS) survey of patient experience; to apply statistical methods to determine what dimensions of patient care have the greatest impact on overall satisfaction scores and thus reimbursement (Carter & Silverman, 2016). This is interesting to think about from a Christian perspective. How would our scores as Christians look if God used our performances as a ranking scale? If he calculated all our days that we did a bad job versus days that we did a good job. Would our scores be worthy enough to go to heaven? We can be encouraged to know that God is not keeping score for those who have put their faith in Him. “If you, O Lord, should mark iniquities, O Lord, who could stand, But with you, there is forgiveness, that you may be feared” (Psalm 130:3-4, English Standard Version).
In addition, in 2013 providing opportunities for enhancement on improving preventative health care coverage, expanding bundled payments, and the health insurance marketplace is initiated (Harrington, 2016). As well as implementing the Health Insurance Marketplace to help individuals and small businesses purchase affordable insurance (Harrington, 2016). In 2014, wanting to protect new consumers by decrease discrimination against individuals with pre-existing conditions, prohibiting insurance companies from charging higher rates due to gender or health status, apply tax credits for the middle class, and increased access to Medicaid (Harrington, 2016). In 2015, improving quality is still moving forward and physician payments will be tied to quality care that they provide to patients (Harrington, 2016). Physicians that provide a higher quality of care will receive higher payments (Harrington, 2016). Speaking from experience from working at a Level II trauma facility before the ACA as well as after the ACA was implemented. I understand and agree with the goals of the ACA however, when talking about the quality of health care facilities do not want to hire more staff. There is a huge increase in workload that it takes to cover these implementations. Staff become overworked and are unable to perform at a “quality” rate. Staff is required to perform tasks more quickly at a rushed paced which can lead to medical errors. So, in this case, this type of service is not improving the quality of health care that is being proposed in the ACA.
When patients are being asked to pay for their provided services and their payment for services has been denied, they now have a right to appeal the decision of the insurance company (Harrington, 2016). A patient must put the appeal in writing to question the decision (Harrington, 2016). The insurance carrier will review the written appeal and compare it to their policy to determine if the decision follows it (Harrington, 2016). If an insurance company decides to deny a claim then they are responsible for notifying the patient the denial and why the claim was denied (Harrington, 2016). The patient has the right to request an external review and receive help from the Consumer Assistant Program (Harrington, 2016). This can be a long process to establish different committees to gather information about a claim with the insurance company (Harrison, 2016).
Carter, J. C., & Silverman, F. N. (2016). Using HCAHPS data to improve hospital care quality. The TQM Journal, 28(6), 974-990. doi:10.1108/tqm-09-2014-0072
Center for Medicare & Medicaid Services. (2017). Retrieved January 28, 2019, from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Hospital_VBPurchasing_Fact_Sheet_ICN907664.pdf
Harrington, M. (2016). Health care finance and the mechanics of insurance and reimbursement. Burlington, MA: Jones & Bartlett.
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