18 Jul 2022

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How Will the New Departmental Regulations Impact Reimbursement?

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Academic level: College

Paper type: Research Paper

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The Centers for Disease Control and Intervention is a national public health institute in the US under the Department of Health and Human Services. It is one of the leading health organizations in the country. It is organized into various departments, some of which utilize reimbursement data differently based on factors such as their characteristic requirements, number of personnel and budgetary allocations. These departments are termed as ‘Centers, Institutes and Offices (CIOs)’. The National Institute for Occupational Safety and Health (NIOSH) for instance, specifically handles health matters with regard to workplaces. As a result, it has the effect of necessitating the need to come up with statistics as well as regulations governing work-related health factors. These include aspects such what can be termed as occupational hazard and what is required of both the employer and employee in the event that an individual has health issues caused or experienced at work. The Office of Infectious Diseases (OID), which deals with diseases that are communicable requires intense reimbursement data as the scope it handles is very large. In order to ensure cost effectiveness as well as a seamless process, this department has to have functional dependency. The overall impact of this is special focus on this department in the entire reimbursement process as it comes across as the most demanding department. Other departments such as the Office of Non-communicable Diseases, Injury and Environmental Health (ONDIEH), the Office of Public Health Preparedness and Response (OPHPR), and the Office of Public Health Scientific Services (OPHSS) are responsible for a variety of tasks which require very qualified personnel and cutting edge equipment (Kelley 12) . This definitely translates into big budgetary requirements to sustain it. 

In the case of the CDC, the most effective type of audit would be the Five Star Program which is normally conducted throughout the year. It measures the quality of the health plans adopted all year round hence it is a direct reflection of whether the reimbursement impacts have been achieved, whether in full or partly. Given the diverse nature of the aforementioned departments, this audit takes care of discrepancy that exists among them. Patient experience, sustained quality measures of achievements and performance are all key aspects of this audit hence it is the most effective for such an organization. On pay-for performance incentives, the impact of the departments can be measured using the figures on how much actually goes into the departments as payment in terms of incentives (Herbert 27) . Since pay-for performance is based on output, both of these variables are quantifiable hence it is possible to associate them with a certain figure. 

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The NIOSH entails activities which demand detailed focus on job-related matters. As a result, these activities will influence reimbursement in such a manner that there will be a meticulous process that will go into determining how much funds will be injected into it. OID activities are more inclined towards combating infectious diseases which are very common resulting in an overall impact on the reimbursement process yielding a considerable portion of it being accorded to this department (Harrington 18) . The remaining two departments bear similarities in how much funds is allocated to facilitate them hence they have a similar impact on the process with a particular effect of a majority of the reimbursement being directed to them. 

The Office of the Associate Director for Policy is responsible for ensuring compliance with coding and billing at the CDC (Kelley 32) . This department provides a comprehensive list citing the policies to which all departments are required to abide by. It therefore acts as the oversight of the organizations meaning there is some slight difference in which it is perceived as compared to the rest of the departments. Consequently, there has to be some flexibility when allocating funds to this department. It follows that it has a different effect on the reimbursement. This is for the sole reason that restraint is exercised with regard to the department hence it tends to get a little less relative to the rest. This also acts as a means of control as it gives a good example of being cost effective. 

Reimbursement in health organizations is vital as it determines the amount of money directed towards officials, staff and departments in general. These departments have to be funded to run their mundane activities hence their impact should be closely monitored to affirm that they do not exceed what is set aside for them. Reimbursement is closely related to cost effectiveness as it seeks to provide enough funds without the liability of incurring unnecessary costs. 

References 

Harrington, Michael K. Health Care Finance and the Mechanics of Insurance and Reimbursement . Jones & Bartlett Learning, 2015. 

Herbert, Kyle. Hospital Reimbursement: Concpets and Principles . Productivity Press, 2012. 

Kelley, Bob. Centers for Disease Control and Prevention . Arcadia Publishing, 2015. 

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StudyBounty. (2023, September 17). How Will the New Departmental Regulations Impact Reimbursement?.
https://studybounty.com/how-will-the-new-departmental-regulations-impact-reimbursement-research-paper

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