Medicare’s Program Impact to Licensure, Accreditation, Reporting, Services, and Patient Care

Medicare Overview
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Medicare Overview
I. Introduction
Attention Getter: Medicare is considered the primary payer under specific conditions.
Thesis Statement: Medicare’s payer program significantly impacts hospitals’ and physicians’ reimbursements, particularly if they are not participants.
II. Body
A. How Medicare’s payer program affects licensure.
Hospitals and physicians ought to be licensed in their respective states for them to participate in Medicare’s payer program.
Each case of the inpatient prospective payment is determined by the diagnosis-related group (DRG) (CMS.gov, 2020).
B. How Medicare’s payer program affects:
Quality reporting systems.
The value-based purchasing (VBP) program gives acute care hospitals incentive payments based on the quality of care they provide (CMS.gov, 2020).
Merit-Based Incentive Payment System (MIPS) determines the adjustments for Medicare payment. For example, by using the composite performance score, clinicians who are eligible might receive a payment penalty, bonus, or adjustment (AAPMR.org, 2021).
Healthcare services reimbursement.
The participating healthcare providers accept Medicare by taking the assignment (Medicareinteractive.org, 2021).
Medicare pays for medical tests that are ordered by opted-out doctors (Kriss, 2011).
Resource-based relative value scale (RBRVS) refers to the physician system of payment that the Centers for Medicare and Medicaid Services (CMS) uses.
RBRVS works on the principle that physicians’ payments should vary based on the resource costs that depend on physician work, professional liability insurance (PLI), and practice expense (AMA, 2021).
Patient access to medical care.
Physicians opt-out of Medicare because of red tape and regulations.
The shortage of primary care physicians graduating from medical schools reduces Medicare and impact access. For instance, the United States of America (USA) will likely to lose about 100,000 physicians by 2025 (Court, 2016).
C. Effect of health information on community health educator
The following shows the responsibilities of a community health educator and how Medicare’s payer program influences it:
Community health educators assess individuals’ health needs.
Develop materials and programs to teach community members about specific health topics.
Help individuals find relevant information on health services.
Train and supervise staff who oversee health education programs.
Community health educators impact Medicare’s payer program by ensuring that resources needed by specific demographics are provided.
Medicare’s payer program compensates licensed community health educators based on the healthcare services they offer.
III. Conclusion
Restate Thesis: Medicare’s payer program influences health institutions and doctors, and it benefits those who are participants.
Overall Remarks: Only licensed and participating healthcare providers can accept Medicare, and by doing so, they agree to take the assignment, meaning that they accept the amount approved by Medicare fo...