Health Care Finance Articles, Article Review Example

Massachusetts Preps for IDC-10 Mandate. Information Week. Ellis Booker. 18 February 2014. http://www.informationweek.com/healthcare/clinical-information-systems/massachusetts-preps-for-icd-10-mandate/d/d-id/1113873

This article from Information Week addresses the ICD-10 coding mandate that is required in all US healthcare providers by October 1, 2014. Based on this mandate, organizations will be required to be in compliance with these activities by the deadline; however, the costs associated with implementing ICD-10 coding are excessive. In Massachusetts, a testing initiative to evaluate ICD-10 systems has been established in order to reduce the costs associated with the implementation effort. The testing program, managed by the Massachusetts Health Data Consortium, is designed to evaluate some of the most common scenarios that might occur in clinical settings and how these are observed in the context of the new system.

The testing platform is also appropriate for Massachusetts because the state already has experience with the New England Healthcare Exchange Network. The ICD-10 mandate is perhaps the most significant issue, as a mandate with a specific deadline places significant pressure on organizations to meet the specific requirements of the mandate. In addition, this is not a cost effective mandate, thereby increasing the burden for healthcare organizations to properly implement the IDC-10 effort without financial assistance.

I believe that although an ICD-10 coding program has its merits, it is also important to note that there are significant challenges for organizations with older systems to implement the new system under a strict deadline. Also, the costs associated with implementing this effort are very high; therefore, it leads to an extensive burden for healthcare organizations, particularly those who are not currently equipped with the technology that is required to implement the system successfully. The costs of performing the upgrade may impact operations in other areas, which is not an efficient use of available resources.

NC proposes experimental health networks for Medicaid patients. Lynn Bonner. 26 February 2014. http://www.newsobserver.com/2014/02/26/3656791/state-proposes-experimental-health.html

This article from the News Observer addresses a program proposed by the state of North Carolina in order to establish a more effective response to Medicaid-related costs. To date, there have been many errors related to inaccuracies in the Medicaid budget that have led to a state of disarray. Therefore, the proposed effort will adopt accountable care organizations, rather than to accept large managed care companies. By using accountable care organizations, it is possible that there will be greater control over Medicaid costs and the ability to manage these costs on a state level rather than through national interference. With accountable care organizations, there is a set budget in place to provide patient care and treatment, thereby ensuring that costs are kept under control, while also enabling the network to potentially keep some of the funds that are not required for patient care. On the other hand, this scenario requires the network to cover any costs that go above and beyond the budgeted amount. This strategy appears to have potentially positive impacts for patients and provides a greater understanding of their needs, based upon cost structures and the amount of funding that is required to provide high quality care and treatment to patients.

I believe that this scenario and the use of accountable care organizations will have a positive impact on cost containment in North Carolina, as well as in other states where this strategy is adopted. This is an important tool in providing a basis for evaluating patient care quality and the level of care that is provided to patients, given the cost limitations that are observed. This process supports the growth of a state-funded strategy to improve cost management within healthcare organizations for Medicaid-related services.

Congress to HHS: ‘Reform the RAC Process.’ David Pittman. 14 February 2014: http://www.medpagetoday.com/PublicHealthPolicy/Medicare/44315

This article addresses the importance of Recovery Audit Contractors (RACs) and their contributions in the effort to reduce fraud within healthcare organizations with respect to Medicare. RACs are an independent investigatory group which is tasked with evaluating Medicare claims in order to determine those that are accurate versus those that are fraudulent. RACs are essentially designed to ensure that Medicare payments are made properly under conditions where claims are accurate and also appropriate. However, there is a downside to this practice, as these groups may become ruthless in their efforts to identify fraudulent claims, thereby compromising the integrity of the system and its actions. These groups have a poor reputation in many national circles because they are viewed in a negative context and perhaps take these roles too seriously, as many claims that appear to be legitimate are denied, thereby increasing the number of appeals that are brought forth to the HHS Office of Medicare Hearings and Appeals (OMHA). This has, in turn, increased the administrative burden that exists within the DHHS and its offices. As a result, Medicare essentially must shift some of its cost burden to other areas, including its appeals division.

I believe that although RACs have some degree of merit in their efforts to distinguish between different types of Medicare claims, their efforts are perhaps too enthusiastic and have given these organizations a bad reputation, as they attempt to overcompensate for the legitimate fraud that exists within the Medicare system. A toned-down yet thorough approach is necessary in order to accomplish the desired objectives and to demonstrate the value of this system and its impact on improving Medicare and reducing fraud.

References

Bonner, L. (2014). NC proposes experimental health networks for Medicaid patients. News Observer, retrieved from http://www.newsobserver.com/2014/02/26/3656791/state-proposes-experimental-health.html

Booker, E. (2014). Massachusetts Preps for IDC-10 Mandate. Information Week, retrieved from http://www.informationweek.com/healthcare/clinical-information-systems/massachusetts-preps-for-icd-10-mandate/d/d-id/1113873

Pittman, D. (2014). Congress to HHS: ‘Reform the RAC Process.’ Retrieved from             http://www.medpagetoday.com/PublicHealthPolicy/Medicare/44315