Task 1 MEDICARE HEALTHCARE ECOSYSTEMS C799 Healthcare Ecosystems.docx

Additionally to ensure the guidelines are being

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Additionally, to ensure the guidelines are being followed, Medicare uses Clinical Quality Measures(CQM) to “...Measuring and reporting CQMs helps to ensure that our health care system is delivering effective, safe, efficient, patient-centered, equitable, and timely care. CQMs measure many aspects of patient care, including: Patient and Family Engagement, Patient Safety, Care Coordination, Population/Public Health, Efficient Use of Healthcare Resources, Clinical Process/Effectiveness” [CMS17]In simple terms, CQM reporting helps ensure that healthcare facilities are providing the highest quality of care to patient’s first time and every time. To elaborate, providers contracted with Medicare must adhere to structured format of electronic health recording(EHR) in order to capture and share patient data reported to CQM. To explore further, Medicare provides two types of benefits; fee-for-service or the managed care plans. Individuals who receive Social Security benefits are automatically enrolled in Medicare part A, premium free. Medicare part A covers 90 days per benefit period for inpatient stays deemed medically necessary, Skilled Nursing Facility(SNF), Home healthcare and Hospice care. Additionally, Medicare provides 60 lifetime reserve days in which can be used at the 91st day of inpatient admission to a hospital or SNF. After the lifetime reserve is has been exhausted LTR will not be reinstated. Next, services not covered under Medicare part A are services covered under Medicare part B, services not deemed medically necessary, to name a few. Moreover, Medicare Part A imposes an annual deductible per admission and a copayment for admissions longer than 60 days
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MEDICARE HEALTHCARE ECOSYTEMS 4 within benefit period. Also, benefit period starts the day you are admitted and ends the day you are discharged. Another essential insurance health benefit provided is Medicare part B. Unlike Medicare part A, Medicare part B coverage is available by paying a monthly premium. In return, Medicare part B covers outpatient visits, preventive services, and durable medical equipment, intermittent rehabilitation and physical therapy, and much more. According to
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  • Fall '17
  • Health care provider, C799, MEDICARE HEALTHCARE ECOSYTEMS

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