2010年的《合理医疗费用法案》(Affordable Care Act)为一些为医疗保险受益人提供医疗服务的机构提供了一种新的支付模式。医疗保险建立了一种基于病人价值或结果的报销方法，而不是按服务收费。这一变化有助于打击过去的欺诈性多付账单的做法。2015年通过的《医疗保险准入和芯片再授权法案》(Medicare Access and CHIP Reauthorization Act)为其他措施铺平了道路。质量支付计划也已经实施，并根据成本、质量、结果和提前护理信息对提供者进行补偿。根据项目的标准提供高质量护理的提供者比那些表现不佳的提供者享有更高的补偿率。保护病人健康信息(PHI)、电子处方、电子病人获取以及促进交换健康信息也是需要衡量的指标。所有这些指标都是为了防止欺诈、浪费和滥用医疗保险基金。2016年超过400亿美元的医疗保险支出是“不正当的”。这些付款不一定都是彻头彻尾的欺诈。这些“不当”付款的主要原因是没有文件，缺乏足够的文件，没有医疗需要的文件，以及不恰当的编码。OIG和CMS建议供应商制定合规计划，为员工提供合规方面的培训，制定书面政策和程序并执行，任命合规专家，进行有效沟通，进行内部审计，并对发现的问题做出回应。对员工进行适当的合规程序教育，可以减少因键控错误而支付的不当款项，也可以减少多付账单或编码更新。有一个合规经理或官员是避免医保欺诈的关键。合规部门的职责是及时更新法规和覆盖指南标准。合规经理或部门随后通过培训或其他沟通方式将信息传递给实践中的相关人员。
澳洲健康学作业代写 合理医疗费用法案
The Affordable Care Act of 2010 put a new payment model into place for some providers treating Medicare beneficiaries. Instead of fee-for-service, Medicare established a patient value or outcome based reimbursement methodology. This change has helped to combat fraudulent overbilling practices of the past. The Medicare Access and CHIP Reauthorization Act of 2015 passed and paved the way for other enforcements. The Quality Payment Program is also in place and reimburses providers based on cost, quality, outcome, and advancing care information. Providers who give quality care according to the metrics of the program are entitled to higher reimbursement rates than those providers who perform poorly. Protecting patient health information (PHI), e-prescribing, electronic patient access, and the promotion of exchanging health information are also metrics that are measured. All of these metrics combat fraud, waste, and abuse of Medicare funds.Just over $40 billion in Medicare payments in 2016 were “improper”. These payments were not all necessarily outright fraudulent. The main reasons for these “improper” payments were no documentation, lack of sufficient documentation, no medical necessity on file, and improper coding. The OIG and CMS suggest that providers form compliance programs that provide employee training on compliance matters, have written policies and procedures and enforce them, appoint a compliance professional, develop effective communication, internally audit, and respond to identified issues. Educating staff in proper compliance procedures can reduce improper payments for keying errors as well as overbilling or upcoding. Having a compliance manger or officer is key in avoiding Medicare fraud. Compliance departments are in place to stay up-to-date on regulations and coverage guideline criteria. The compliance manager or department then relays the information via training or other methods of communication to pertinent staff within the practice.