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5 things you should know about Universal Healthcare coverage and the Impact on Informatics.

June 11, 2008
by Pete Rivera
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5. Indigent care, write offs and grants will be severely limited. “Charity care”, community clinics and community hospitals will need to become leaner and more efficient as they compete with other hospitals now accessible by their patient base. Translates to improved Electronic Health Records, improved front end processes and streamlined reimbursement processes for these organizations.

4. Most reimbursement levels will follow Universal coverage rules. But there may also be additional compensation for Preventive Medicine procedures, decrease patient wait times and other government metrics. Translates to a need for improved links between Electronic Health Records and claims submission.

3. New federal standards and centralized payer centers will reduce or eliminate state level programs. Translates to new EDI requirements and interfaces.

2. Benefits eligibility will be tied to Universal Patient Identifiers which means requiring accurate, reportable demographic information in order to obtain government reimbursement. Translates to improved eligibility verification at point of care.

1. The need for Private Medical Insurance (PMI) will rise similar to the model. Translates to new contracts, EDI and the need to keep multiple insurance payer tables within Hospital Information Systems.


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Comments

Not quite sure how to word this, but there will be a need to bill every billable dollar for maximum reimbursement, better level of care coding, better documentation to support that coding, charging for nurse only visits which currently are often "free" - all things a good EMR can help with

thanks


Posted for:
Mary Charnes RN


I think you can expect to see more Utilization review with fewer choices for those who the can't expect the best outcomes for procedures.

Continued push for a pay for performance model with Universal Care process. Universal care means all people will receive some care, but not all people will receive all the care they expect or want.
Posted for
Linda Howrey

Pete,

Spot on. Unfortunately, UCP will not cut down on the amount of fast food that we consume. It merely pays for the Cath procedure that patients will need later on. However, having good information on the procedure for future cardiac events will be helpful. So at least we have that going for us!


Cheers!
Posted for
Peter Zazzara

I'm happy you are accumulating a wide range of points of view on the American human services framework. Assignment writing service uk I emphatically trust that the framework is fixed to bolster the protection business. The costs of medicinal services without protection is unbelievable.

Catastrophic universal health insurance I might agree with, but not this mess they call Medicare. Between, poor people can't afford the premiums, and if they qualify for extra help now they get much better health insurance than Medicare, it is called Medicaid. essay writing services. So this whole thing about it is to help the poor is a flat out lie.

Pete Rivera

Director Informatics, Hayes Management Consulting

Pete Rivera

@Gator_Pete

www.Hayesmanagement.com

 

 

 

 

 

 

 

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