Differentiate between licensure, certification, and accreditation as it applies to healthcare facilities.
Include the following in the discussion:
REPLY TO MY CLASSMATE’S DISCUSSION TO THE ABOVE QUESTION AND EXPLAIN WHY YOU AGREE. (MINIMUM OF 200 WORDS EACH)
Licensure, certification, and accreditation allow healthcare organizations to market themselves to patients to seek care there (Wager, Lee, & Glaser, 2017). Healthcare facilities, including hospitals, nursing homes, and home health agencies, can optimize their reimbursement for health services for medicaid and medicare patients must be licensed to operate, certified to file Medicare/Medicaid claims, and accredited to show quality performance. Quality performance is measured and categorized by type, structure, process, outcome, and patient experience. Licensure is given by a states health department and is needed to legally operate in that state. To be a licensed facility they must follow standards for equipment and personnel, and protection, integrity, and reliability of patient health information. CMS certification creates standards for conditions of participation for Medicare/Medicaid patients. These conditions include documentation standards, assessment requirements and outcomes inorder receive reimbursement for Medicare or Medicaid patients, however, private insurance companies follow CMS’s lead for reimbursement standards. Accreditation is a voluntary process and involves an external review by an accreditation organization to see if the facility has met predetermined performance standards. An accredited facility can be exempt from state surveys for CMS compliance (Wager, Lee, & Glaser, 2017).
These three type of regulations on healthcare facilities impact information systems by creating minimum standards that facilities to follow (Wager, Lee, & Glaser, 2017). Licensure requires the protection of patient health information. Patient health information needs to be reliable and maintain integrity to obtain licensing to operate. Certification creates further standards on how and what should be documented. Accreditation organizations such as the Joint Comission also create standards for documentation and protection of patient health information (Wager, Lee, & Glaser, 2017).
Patients can recognize whether a facility has these three regulations because their insurance or Medicare/Medcaid will not cover organizations who are not licensed or certified. Many facilities advertise their accredition to place them above other facilities.
Wager, K. A., Lee, F. W., & Glaser, J. P. (2017). Health Care Information Systems: A Practical Approach for Health Care Management (4th Edition). Wiley Professional Development (P&T). https://ambassadored.vitalsource.com/books/9781119337089
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