Download TRICARE and the Military Health System and more Thesis Business Accounting in PDF only on Docsity!
Task 1 (^0) Task 1 Healthcare Ecosystems A1. Impact on Standards TRICARE is the government payer program for uniformed service members, retirees, and their families. The Military Health System (MHS) is the group of physicians that care for and treat TRICARE members. As of 2014, MHS served 9.6 million Americans. TRICARE covers all members worldwide. This government payer program is managed by the Defense Health Agency, under the leadership of the Assistant Secretary of Defense. TRICARE provides coverage for medical, dental, vision, and more. When a physician wants to become a TRICARE provider, he or she must take certain measures to do so. The practitioner must hold a current, valid license in the state in which they tend to practice. There must not be any restrictions on their license, and stands must have been met. Practitioners must also have a Certified Membership in The National or Professional Association.
A2a. Clinical Quality Reporting Systems As of October 2019, the Clinical Quality Management (CQM) of the MHS took over the quality reporting for TRICARE. This team assesses the quality of healthcare given to member, and patient safety. There are six programs that CQM use to report accurate data and record. Patient Safety, which includes infection prevention in hospital care settings, Healthcare Risk Management, Credentialing and Privileging, Accreditation and Compliance, Clinical Measurement, and Clinical Quality Improvement. The CQM provides structure and framework to MHS to measure and improve the quality of care. CQM provides indefatigable commitment to beneficiaries, joint healthcare, and Combatant Commands all over the world. A2b. Reimbursement for Healthcare Services With TRICARE, there are several different reimbursements for each procedure or treatment. Looking at Long Term Care Hospital (LTCH) and Inpatient Rehabilitation reimbursements, recently these charges are not reimbursed through the Center for Medicare and Medicaid (CMS). For LTCH, which include the Veteran Affairs hospitals, the charges must be submitted for reimbursement within one day from patient discharge. There are special reimbursements for those patients who are in an intensive care unit, or who require artificial ventilation. TRICARE uses Medicare Quality Reporting payment adjustments for LTCH of TRICARE. Since the QR are shared, TRICARE does not establish its own reporting system. TRICARE is currently in year 2 of a transition period of which the amount that TRICARE pays, or reimburses, is going down. Year 2 is from October 1, 2019 to September 30,2020. This year
these ways to access care have individual requirements that the member would have to complete to get care. B1. Role of Health Information Management Professionals A Medical Records Technician Coder who works for the Veterans Affairs and works with TRICARE must know the assigned codes to documented care, current knowledge of the newest ICD-10 coding system, Current Procedural Terminology (CPT) and the Healthcare Common Procedure Coding System (HCPCS). A person in this job also must have skill to search the entire medical record to ensure that all documentation required is accurate and mirrors exactly what care the patient received. Knowledge of Medical Terminology, medications, treatment modalities and others are also a key to successful career as a Coder. Coders also classify medical data from the patients records from a variety of sources i.e. doctors offices, hospitals, surgery clinic, or specialty clinics. TRICARE impacts the job of a medical coder by making the coder focus directly on claims specific to TRICARE. Medical Coders for TRICARE must understand where to find the correct numbers on the ID cards for TRICARE claims. TRICARE impacts this role greatly by allowing these professionals to focus and become masters in the TRICARE reimbursement codes. When working with the Veterans Affairs Hospitals (VA) a coder works closely with those hospitals and making sure that claims are being submitted correctly.
Citations: Clinical Quality Management. (2019). Retrieved July 13, 2020, from https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/Quality- And-Safety-of-Healthcare/Clinical-Quality-Management Clinical Quality Measures. (n.d.). Retrieved July 10, 2020, from https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/Quality- And-Safety-of-Healthcare/Clinical-Quality-Management/Clinical-Quality-Measures Health.mil: The official website of the Military Health System (MHS) and the Defense Health
https://www.tricare-west.com/content/hnfs/home/tw/prov/claims/billing_tips/ OutpatientProspectivePaymentSystem.html Health.mil: The official website of the Military Health System (MHS) and the Defense Health Agency (DHA). (2019, September 20). Retrieved July 15, 2020, from https://manuals.health.mil/pages/DisplayManualHtmlFile/TR15/41/AsOf/TR15/ C16S1.html Medical Records Technician Coder (Inpatient and Outpatient). (2020, July 13). Retrieved July 15, 2020, from https://armycivilianservice.usajobs.gov/GetJob/ViewDetails/
