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Summary C799 Task 1 take 2.docx 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 fo$4.99
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Summary C799 Task 1 take 2.docx 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 fo
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C799 Task 1 take 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 serve...
c799 task 1 take 2docx task 1 healthcare ecosystems a1 impact on standards tricare is the government payer program for uniformed service members
and their families the military health
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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.
, 1
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
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