Case-Study: Documentation and Reimbursement

Case-Study: Documentation and Reimbursement

Case-Study: Documentation and Reimbursement

Week 5 discussion Documentation and Reimbursement What is the impact of Centers for Medicare and Medicaid Services (CMS) payment denial on the healthcare system? What are the implications for our nursing practice related to use of standardized terminology for documentation? How does this impact patient outcomes?The Centers for Medicare & Medicaid Services (CMS), previously known as the Health Care Financing Administration (HCFA), is a federal agency within the  (HHS) that administers the  program and works in partnership with state governments to administer , the  (CHIP), and  portability standards. In addition to these programs, CMS has other responsibilities, including the administrative simplification standards from the  of 1996 (HIPAA), quality standards in  facilities (more commonly referred to as ) through its survey and certification process, clinical laboratory quality standards under the , and oversight of .

President  signed the  on July 30, 1965, establishing both Medicare and Medicaid. , a deputy commissioner of the Social Security Administration, was named as first director of the Bureau of Health Insurance in 1965, placing him as the first executive in charge of the Medicare program. At the time, the program provided health insurance to 19 million Americans. The  (SSA) became responsible for the administration of Medicare and the Social and Rehabilitation Service (SRS) became responsible for the administration of Medicaid. Both agencies were organized under what was then known as the  (HEW).

In 1977, the Health Care Financing Administration (HCFA) was established under HEW. HCFA became responsible for the coordination of Medicare and Medicaid. The responsibility for enrolling beneficiaries into Medicare and processing premium payments remained with SSA.