Essay on Navigating Healthcare: Quality, Compliance, and Financial Perspectives

Published: 2024-01-24
Essay on Navigating Healthcare: Quality, Compliance, and Financial Perspectives
Type of paper:  Essay
Categories:  Finance Medicine Healthcare
Pages: 4
Wordcount: 942 words
8 min read

Joint Commission Accreditation ensures that an organization complies with the set safety standards and quality care alongside the commitment to enhance patient care steadily (Schmaltz et al., 2011). The commission has led to significant benefits for various hospitals and other organizations. Among the benefits attributed to the commission include risk management and risk reduction, where every organization must be careful in how it manages and assesses the risks they have (Schmaltz et al., 2011). My reflection on the commission has led to steady safety improvement for both the clients and service providers. As such, the quality of services offered increases through the management and reduce risks that might affect the safety and the quality of services.

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HIPAA and HITECH are Acts that help in the management of patients' information and other issues (Trinckes 2012). HIPAA is the health insurance Act, which ensures that all patients can access insurance covers to help them undergo treatment in hospitals. On the other hand, HITECH supports technology and electronic storage of health records for patients, thus, securing them from getting into the wrong hands (Trinckes 2012). These two acts have led to improved services where the clients' safety and well-being have been guaranteed. The government should continue enforcing them to ensure that the public reaps various benefits associated with them, such as those mentioned herein.

Healthcare Finance is a fund that is set aside to cater to the public's healthcare needs, especially those that may not afford it (Giniat, 2011). It helps in the management of money for medical resources. The patients through this program can access healthcare and their bills paid. Critically thinking, this is a critical program that targets people from different walks of life. A poor person can access safe and quality healthcare from the right healthcare providers. The program is therefore useful in ensuring equality and promotion of health and life.

Revenue Cycle is all administrative and clinical roles that lead to management and collection of money from patients who have been served (Rauscher & Wheeler, 2010). The money is used to cater to other needs in the healthcare systems. It seems to be the right approach towards the quality delivery of healthcare services to patients. However, this might lead to expensive healthcare services, which may lock out other patients who cannot afford anything to pay for the services.

The Recovery Audit Contractor is a critical unit as it is charged with detection and correction of the previous inappropriate payments so that measures can be put in place to assist in the prevention of future improper payments (Goldberg & Young, 2011). To me, the unit is instrumental in ensuring that the funds set aside to cater for various bills have been appropriately used to reduce the chances of looting public resources meant to cater to healthcare services.

The OIG work plan is a protocol that sets diverse programs to include auditing and analyzing what is underway or planned to address during a fiscal year and beyond (Brown, 2011). The work is done by the OIG's office of audit, evaluations, and inspection (Brown, 2011). According to my thinking, the OIG work plan is a critical strategy for the accountability and production of well-planned and organized activities that are beneficial to the public.

An organization abides by the Corporate Integrity Agreement in exchange for the Office of the Inspector General contract that will not exclude the organization from taking part in healthcare, medical assistance, and other federal healthcare plans (Babcocka & Rainsb, 2012). Therefore, the CIA is a critical tool in ensuring equitability and inclusion of all into the government programs on healthcare and health promotion among all without discrimination.

The False Claim Act is a federal Act enacted to address the defense of a fraud contractor. The Act offered that a person who deliberately provides false information to the government is liable for a double penalty of $2000 for each false claim (Howard & Desai, 2020). After critically analyzing the Act, I concluded that the Act was instrumental in the war against false allegations that have led to a misleading decision, among other issues.

A provider who is willing to volunteer to provide self-discovered evidence of a purported fraudulent activity to the Inspector General's office is allowed to do that under the provider self-disclosure protocol (Martini & Houlton, 2010). Through this, I identified that such a person is protected from any threats posed to them by the suspects they report. Additionally, this is a good move towards fighting fraud.


Babcocka, T., & Rainsb, C. (2012). Corporate Integrity Agreements 2012.Brown, J. (2011). Have You Taken a Look at the 2011 OIG Work Plan?. Catherine M. Boerner, Jd, Chc, 37.

Giniat, E. J. (2011). Using business intelligence for competitive advantage: the use of data analytics is emerging as a key discipline for healthcare finance. Healthcare Financial Management, 65(9), 142-145.

Goldberg, A. J., & Young, L. M. (2011). What every CEO should know about Medicare's recovery audit contractor program. Journal of Healthcare Management, 56(3), 157-162.

Howard, D. H., & Desai, N. R. (2020). US False Claims Act investigations of unnecessary percutaneous coronary interventions. JAMA Internal Medicine, 180(11), 1534-1536.

Martini, J. W., & Houlton, S. A. (2010). HHS Should Expand Its Self-Disclosure Protocol.

Rauscher, S., & Wheeler, J. R. (2010). Hospital revenue cycle management and payer mix: Do Medicare and medicaid undermine hospitals’ ability to generate and collect patient care revenue?. Editorial Board, 37(2), 90-104.

Schmaltz, S. P., Williams, S. C., Chassin, M. R., Loeb, J. M., & Wachter, R. M. (2011). Hospital performance trends on national quality measures and the association with Joint Commission accreditation. Journal of hospital medicine, 6(8), 454-461.

Trinckes Jr, J. J. (2012). The definitive guide to complying with the HIPAA/HITECH privacy and security rules. CRC Press.

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