Task 1 MEDICARE HEALTHCARE ECOSYSTEMS C799 Healthcare Ecosystems.docx

To be paid for services rendered providers must

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“To be paid for services rendered providers must document the services as medically necessary or prescribed as a preventative visit. Conversely, services not covered by Medicare are cosmetic surgery, dentures and dental care, hearing aids and hearing aid fitting, and acupuncture. Subsequently, services not covered by Medicare Part A and B maybe covered by Medicare Advantage. Medicare Advantage also, known as Medicare part C was implemented in 1997 by Balance Budget Act(BBA) and later rename by the Medicare Modernization Act(MMA) in 2003 to Medicare Advantage. Medicare Advantage provides recipients the capability to select different healthcare plans beyond the traditional fee-for-service plans previously provided and the amongst the highest growing plans provided to date. According to the Kaiser Family Foundation it is said “In 2017, the majority of the 57 million people on Medicare are covered by traditional Medicare, with one-third enrolled in Medicare Advantage plan. Since 2004, the number of beneficiaries enrolled in a in private plans has more than triple from 5.2 million (13%) to 19.0 million in 2017(33%).” [Kai17]. Over the years, statistic has shown that Medicare Advantage has accelerated compare to the traditional fee-for-service with the expansion of Medicare Advantage.
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MEDICARE HEALTHCARE ECOSYTEMS 5 Furthermore, majority of Medicare beneficiaries throughout the country have good access to medical care that allows access to many healthcare providers. However, rural communities have struggled with access to healthcare due in part to remoteness from healthcare provider. Center for Medicare and Medicaid Services(CMS) announced quality improvement initiative to advance healthcare in rural areas known as the Frontier Community Health Integration Project(FCHIP) to 10 Critical Access Hospitals(CAH). The goal is to provide programs to CAH “ of improving quality of care, increasing patient satisfaction in rural communities, and spending health care dollars more wisely. The demonstration will provide financial incentives for care coordination activities for local CAHs to reduce unnecessary admissions and readmissions across their networks of care.” [CMS16] . Access to healthcare is essential and the goal to improve patient care is
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  • Fall '17
  • Health care provider, C799, MEDICARE HEALTHCARE ECOSYTEMS

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