This website uses cookies to ensure you have the best experience. Learn more

The Affordable Care Act (Aca) And Hospital Compliance

1565 words - 7 pages

Abstract
The Affordable Care Act (ACA) brings a myriad of changes to the healthcare system and hospitals must adapt accordingly or face dire financial challenges. Some of the financial challenges will originate from the influx of Medicaid patients due to the Medicaid expansion. Based on these changes, there is an increased tendency for hospitals to engineer ways to reduce costs such as patient selection and staff reduction. However, for a hospital to participate in Medicare, which accounts for more than 50% of hospital budgets, certain laws and regulations must be followed. This paper discusses these laws and regulations and offers suggestions on how to adjust successfully to the upcoming ...view middle of the document...

Nonetheless, there are regulations that apply to patient selection that must be followed in order to ensure compliance with federal laws and prevent legal action against the healthcare organization. One of such regulations is the Emergency Treatment and Active Labor Act (EMTALA), which requires any hospital that participates in Medicare to provide medical treatment to all individuals that present at their emergency department with an emergency medical condition (EMC), regardless of their ability to pay (CMS, 1986). The ACA requires continued adherence to EMTALA and goes further to require non-profit hospitals to openly publish information about how individuals can receive financial assistance for their bills. Failure to comply with EMTALA’s guidelines may result in termination of the hospital’s participation in Medicare, as well as monetary penalties.
Another regulation of importance is the “Conditions of Participation” in the Medicare and Medicaid programs. Of particular importance is the rule that requires an increase in patient-centered care for all hospitals through internal assessment of quality, safety, and studying adverse events (CMS, 2003). These measures apply to all patients in the hospital with no room for selectivity and are accessed during onsite visits by Medicare officials. For instance, hospitals should not reduce the number or type of tests/treatments offered to a patient based on the type of insurance coverage they have or if they are uninsured or covered by Medicare/Medicaid. Since Medicare supplies more than 50% of the hospital’s reimbursements, it is imperative that these guidelines are strictly adhered to.
A third regulation, the False Claims Act (FCA) oversees inaccurate billing for services covered by Medicare and Medicaid (Kim, 2009). For instance, overbilling, under-billing or waiving the fee for a service covered by the government or private insurance is considered a false claim. According to Weiner (2001), the tendency to over-, under-, or not bill for a service arises mostly when providers are faced with patients that need a certain standard of care but the reimbursement from their third party payer is insufficient. Thus, physicians may opt to waive the coinsurance or copayment fees for patients who express financial difficulties (Weiner, 2001). Persistence of such practice may lead to violations of the Medicare and Medicaid anti-kickback statute, because providers who consistently waive fees for patients, may become favored by certain patients, providing unfair marketing advantage to the hospitals or practices they work for (Weiner 2001).
In order to adapt to these changes, while remaining compliant with healthcare laws and maintain quality care, the following suggestions are warranted. First, the hospital should consider developing increased affiliations with primary care physician groups, urgent care centers, and retail clinics such as the CVS pharmacy minute clinics. Affiliating with these groups will...

Other Essays Like The Affordable Care Act (Aca) and Hospital Compliance

The Act Of 2003 And 1991

1025 words - 5 pages -out of future pre-recorded telemarketing calls using an interactive, automated opt-out mechanism, and limit permissible abandoned calls on a per-calling campaign basis, to discourage intrusive calling campaigns. This is also ties into the Health Insurance Portability and Accountability Act of 1996 the commission exempts Tele-marketing calls to Consumers made by Health Care related entities in which gives Consumers “greater protection” from

Children’s Hospital Case Study and the Relationship with the Readings from Managing Change: Equity & Action

1044 words - 5 pages conducted with all the medical practitioners in the hospital. The sessions created commitment for the safety effort. All the employees felt relieved to have a safe place to share their experiences with medical errors. Morath went ahead, after getting approval to hold focus group sessions with parents where they shared out and made suggestions for improving patient care. They formulated a strategic plan. During the second half of 1999, Morath launched

The Organisation Health and Social Care Services

644 words - 3 pages ), which discusses the management and provision of services. 3. Caring for people (1989), concerning community care. 4. The new NHS (1998), which sets out the future of the NHS. In addition to these white papers, the NHS and Community Care Act 1990 had important consequences for the way health and social care agencies are organised. At the centre of the reforms to health and social care was the idea there should be a clear division between

The Rise Of Medicine And Medical Care

1909 words - 8 pages The Rise of Medicine and Medical Care A period of growing interests and a time of “rebirth” known as the Renaissance, led to many discoveries about medicine. This was a time to learn new knowledge and make advances in the medical area. Breakthroughs were happening all throughout this time which soon led to the realization that the heart pumps blood around the body. This was one factor that helped doctors find ways to help the wounded. The

Feminism and the Ethics of Care

703 words - 3 pages PL431 Feminism and the Ethics of Care(Chapter 11)- Reading #3 11.1 Do Women and Men Think Differently about Ethics? This topic and question is of great interest to me being that I myself am a woman. So in my opinion do women and men think differently about ethics? I personally think that they do, but it all comes down truly in the end to the individual person and their thoughts on ethics. I do agree that women’s virtues make women very

The Rise And Fall Of The National Industrial Recovery Act

1803 words - 8 pages the end of 1934. The main cause was the person in control of the National Recovery Act. Industrialists became to see General Johnson as a dictator, who was trying to keep the businessmen under pressure. Johnson’s personal behavior, drinking problems, and the way he forced industrialists to create certain codes contributed to disaffection with him inside and outside the White House. There were rumors about his affair with former Democratic

The Patriot Act and Its Effect on Corporations

3276 words - 14 pages The Patriot Act and its Effect on Corporations SECR 5080 – Term Paper 9 May 2015 Table of Contents Abstract – page 3 Introduction – page 3 Current State of Affairs as by the law – page 5 Impact on computing – page 6 Surveillance on Businesses – page 9 Penalty on non-compliance – page 10 Internet Service Providers – page 10 Conclusion – page 12 References – page 13 Abstract The Patriot Act was written into law just a mere 45

The Cost and Spending of Health Care: Why Universal Health Care

593 words - 3 pages health care spending is to create a universal health care to make sure everyone is covered. By creating a universal health care, it will help decrease the number of lobbyers which in turn will cut government funding to those special interest groups. There are 45 million Americans uninsured and according to CNN report 45,000 Americans die each year due to lack of affordable health care. So by creating a universal health care, we can be sure to

Canadian Public Policy And Administration - Employment Equity Act, A Short Paper Evaluating The Success Of The Act

2470 words - 10 pages Commission, the federal government implemented 'The Employment Equity Act' in 1986. This short paper will evaluate the success of the 'Act' and will argue that although some progress has been made, the Canadian Labour force still does not reflect the demographic composition of Canada as the Act had targeted.For the purposes of implementing Employment Equity, certain individuals or groups who are at an employment disadvantage are designated to

Health Care System in the U.S. and Changes by Obama

3386 words - 14 pages reform. And they failed spectacularly. Can Obama fare any better? Anyhow we know that this is not an easy job because many of his political objectors oppose his ideas. In this chapter I will try to point out what already has happened, what still needs to be done, what the problems are and some ideas which could solve them. 5.4 Reform of the System One of the first steps which were taken was the “Affordable Care Act”. It actually was

The History and Evolution of Health Care Economics

1042 words - 5 pages ease the health care issue; Baylor Hospital implemented a system which would later be known as Blue Cross. This system was created to help people pay for health care as the cost continued to increase due to great advancements in medicine. Because of the success of this plan, many other companies decided to offer health insurance and many employers decided to adopt this idea and use it to lure potential employees as there was a shortage of laborers

Related Papers

The Patient Protection And Affordable Care Act

1943 words - 8 pages The Patient Protection and Affordable Care Act (PPACA) is often referred to “Obamacare”. This act was signed by president Barrack Obama on March 23, 2010. The PPACA will ensure all Americans have access to quality, affordable health care with lower prices. The government claims that the act is fully paid for and gives most Americans the quality health insurance that they deserve. The goal of this act is also to reduce the deficit over the next

Affordable Care Act Essay

797 words - 4 pages For years healthcare reform has been a hot topic for politicians everywhere. Being that I personally am relatively healthy and have had health insurance 100% covered by my employer since I entered the workforce, I have never had much concern about the Affordable Care Act. It was just a topic that I felt did not concern me at the time. I saw it as an issue that I would face when the time came for me to be affected by it. Like many aspects in

Positive Facts About The Affordable Care Act Obama Care

3301 words - 14 pages The Affordable Care Act (ACA) or ObamaCare as it is widely known, has been a controversial political debate since day one. The Republicans have tried over 50 times to repeal it, to no avail. Like any other bill, there are good sides and negative consequences to it. People can go to healthcare.gov to sign up for insurance under the ACA. There is a plethora of information on the site about what should be covered, who has to participate, who

Hospital Stretchers Market (By Types: Fixed Height, Adjustable, Bariatric, Radiographic Stretchers And By Applications: Intra Hospital Transport, Day Care Surgery Department, Emergency Department And...

1804 words - 8 pages . By product type, the market is segmented into fixed-height stretchers, adjustable stretchers, bariatric stretchers, radiographic stretchers and others. By technology, the hospital stretchers market is segmented into motorized and non-motorized hospital stretchers. Moreover, the hospital stretchers market is also segmented based on end-users such as intra-hospital transport, emergency department, day care surgery department, pediatric surgery