ACA Acronyms | FFOF | Everything Has an Abbrev.
What do the ACA, ACO, FFS, DHS, and QHP all have in common? They are healthcare acronyms and most are related to the Affordable Care Act.
The healthcare industry is not unlike any other industry or almost any aspect of our lives these days, especially with the advent of texting. There is always a shorter way to say something i.e. “BFF” – best friends forever or one of my favorites “*$” – Starbucks. By the way, the title “FFOF” is Fun Facts on Friday.
The ACA, which is part of the “PPACA” – Patient Protection and Affordable Care Act of 2010, is regulated by “HHS” – the division of Health and Human Services, the “DOL” – Department of Labor and the “IRS” – Internal Revenue Service. HHS designates many responsibilities to “CMS” – the Centers for Medicare and Medicaid Services.
Obamacare & Murphy’s Law | Did It All Go Wrong?
Pundits began outlining the downfall of Obamacare as soon as the President was elected in 2008. Now that many programs have come to fruition, many folks who originally voiced concerns are tallying up the negative outcomes.
Show Me the Money | Profitability Through Value-Based Purchasing
Summary: Are you ready for a shift in risk from payer to provider? Will you be ready for value-based purchasing when it becomes required? Are you utilizing other reimbursement models such as bundled payments, Accountable Care Organizations, and Population Health Management?
From a provider perspective, healthcare reform is aimed at tightening the purse strings, working more efficiently, reducing waste, and improving quality. The shift of risk has begun which will transform healthcare from a fee-for-service to fee-for-value. When the ultimate transformation ends, is still uncertain. As such, fee-for-service is still being utilized and providers are still generating profits and revenue based on the volume mentality while simultaneously trying to transition to a volume and quantity mentality. Juggling the opposite ends of the spectrum is no easy task.
Understanding Utilization Review
When a patient needs medical treatment of any kind, their insurance company needs a way to establish how much they’re going to pay for the services. An insurance company may review a treatment or procedure to determine if it is appropriate, and therefore, if they’ll cover the cost. If an insurance company denies coverage, a patient or healthcare provider can appeal the decision.
Benefits of ACOs to Both Patients and Providers
Summary: Accountable Care Organizations (ACOs) are gaining in popularity as a result of the Affordable Care Act. Have you considered the benefits of ACOs from both the patient and provider perspectives?
One of the goals of the Affordable Care Act (ACA) is to provide coordinated care which, in turn, increases quality and efficiency within the healthcare field, and reduces costs.
ACOs – What is an ACO?
ACOs are groups of providers which form an organization based upon the Medical Home (or PCMH) concept. The Medical Home places responsibility for the coordination of care with the primary physician. The primary care physician coordinates with other physicians and providers such as specialty physicians, laboratories and diagnostic imaging, providing a central point for the patient’s medical information.
3 Reasons Family Physicians/Patients Are Embracing Private Healthcare
As Obamacare policies have gone into effect, more and more people are realizing their quality of care has been sacrificed. They are unable to schedule an appointment with their doctor, and their insurance covers little of what it used to.
Unfortunately, the Affordable Health Care Act could have used more work before going into effect, and both the doctors and patients are suffering. As people and government officials are beginning to realize, the solution to healthcare cannot be fitted with a one size fits all package.
As a result, direct primary healthcare (private healthcare) and concierge medicine is growing in popularity amongst both physicians and patients. Here are three reasons why.
Dual-Eligibility: An overworked & overlooked population?
9 million Americans are covered by both Medicare and Medicaid and are part of a unique community of healthcare consumers known as the dual eligible. Dual eligible beneficiaries often have complex health conditions and may be low income, meaning that their access to healthcare would be greatly limited if not for their dual eligibility for coverage.
Observation Units – Bridging the Gap Between Inpatient and Outpatient
What is CMS doing to reduce healthcare costs? CMS has added observation units which are an additional level of care between inpatient and outpatient.
What Are Observation Units?
In general, observation units are used to bridge the gap between inpatient and outpatient. They are designed for the patient in which the attending physician cannot determine whether a patient should be classified as outpatient (released within 48 hours) or inpatient (expected to stay at least 2 midnights). The observation units enable the physician to have a bit more time to stabilize the patient and based on medical necessity determine the estimated length of stay. They are billed as outpatient and do not count toward an inpatient admission.
How the Health Care Plan Costs Add Up
What makes up the federal deficit? What will the costs be by 2019? How are those costs paid? How do the exchange subsidies factor in? How about the Medicaid expansion? How about the individual and employer mandates or more appropriately the penalties for noncompliance?
What You Need to Know About Medicaid, the ACA, and the Exchanges
How will Medicaid work with the new exchange? What changes have occurred as a result of the ACA?