Question

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 do evidence-based practice guidelines impact patient outcomes and necessitate improved practice care? please answer all questions, i need them well explained, please do not copy and paste, also please reference information...thank you

Answer 1

The Centers for Medicare and Medicaid Services (CMS) obligatory guidelines averting healthcare recompense for medical situations which were assimilated during a patient’s visit in a hospital but were not initially present prior to admittance. Separately from the understandable drive of federal budget reduction and circumventing abuse of administration agendas, this policy also marks hospital value. The result spreads all the way to the hospital organizational construction, down to staff presentation, as well as facility upgrading. To prevent hospital acquired circumstances that might lead to renunciation of Medicare and Medicaid expenditures, the management society will need to comprise facility-related rules during decision-making meetings. Alterations needed include hygienic upkeep of facilities and equipment predominantly, in high traffic areas as well as wards caring for patients with communicable diseases. Patient care excellence is also an influence; hence, all staff – predominantly, those who are directly convoluted with patients must provide quality care.

According to the CMS in several number of situations payment for services are potentially denial because of diversion of personnel, patients unnecessary diagnostic testing and other resources away from general patient care and prevention. It can be leads to resource consumption, personnel, additional time, and reduction or changes in health care worker staffing due to decreased reimbursement” (Sorensen, Jarrett, Tant, Bernard, & McCall, 2014). As a result of these instances, we see less reimbursement, and the subsequent poor standard of care. Nurses and other support staff become stretched, physicians begin to do the bare minimum, or provide excessive orders to increase their chances and likelihood of reimbursement, even though it is counterproductive.

The implications of standardized terminology in nursing documentation provide the nurse the opportunity to be precise about what is seen in the patient, as well as what is done for them. As stated in the textbook, “The nursing process data elements include assessment, diagnosis, outcome identification (goal), planning, implementation (interventions), and evaluation” (Hebda& Czar, pp. 303). We are able to incorporate the nursing process with standardized terminology. “A standardized nursing language should be defined so that nursing care can be communicated accurately among nurses and other health care providers” (Rutherford, 2008). Even if it takes a little more time in your shift, documenting thoroughly will always go a long way. Thankfully, most documentation systems have aligned themselves with CMS requirements. At my workplace, we have the ability to be specific on what we are noting on the patient, in the event that there is a piece of information not listed, we can make a comment to ensure we include all pertinent information. Patient outcomes improve as a result of accurate and thorough documentation, “patients benefit when nurses are precise in the definition and communication of their assessments which dictate the type and amount of nursing care necessary to effectively treat the patient” (Rutherford, 2008).

References:

Hebda, T., Czar, P., (2014). Handbook of informatics for nurses & healthcare professional, (5th ed.). Upper Saddle River NJ: Pearson Education

Rutherford, M. (2008). Standardized Nursing Language: What Does It Mean for Nursing Practice? The Online Journal of Issues in Nursing,13(1). doi:http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/vol132008/No1Jan08/ArticlePreviousTopic/StandardizedNursingLanguage.html

Sorensen, A., Jarrett, N., Tant, E., Bernard, S., &Mccall, N. (2014). HAC-POA Policy Effects on Hospitals, Other Payers, and Patients. Medicare & Medicaid Research Review,4(3). Retrieved April 2, 2017, from https://www.cms.gov/mmrr/Downloads/MMRR2014_004_03_a07.pdf