Managed Care Organizations and Integrated Health Care Networks
Topic 5 DQ 2
The ACC requires the health care facilities be licensed and undergo background checks. Being licensed is crucial in ensuring that proper assessments are done before a health facility is allowed to roll out various services. This also eliminates instances of deviance and negligence hence allowing effective conducting of various activities (Gorin, Darnell & Allen, 2014). My organization always ensures that there is timely renewal and submission of the necessary licensure and certifications that are needed by authorities. There are personnel that are charged with this responsibility hence effective licensure and proper checks on various departments of the hospital.
The ACC requires that hospitals should not be involved in any unacceptable practices or procedures which ultimately lead to increased costs. Fiscal and medical practices that are related to the overall medical cost must be acceptable (Panuganti et al. 2021). My organization keeps conducting require medical enlightenment and education to various stakeholders on how to increase quality and curb instances of going against set rules and regulations.
The ACC needs health providers to report instances of overpayment and ensure that any extra payments are returned within 60 payments of identification. My organization has put strategies in place to check any instances of overpayment. This is done by the accounting officers and any cases of overpayment are returned as soon as possible. Officers that do not make the reports are made to face the disciplinary committee to prevent future instances of going against set measures.
The Affordable Care Act (ACA) identifies requirements related to provider compliance with fraud, waste, and abuse laws that have been enacted to protect consumers. Research three of these requirements and describe the corresponding measures that your health care organization has initiated, or could initiate, to comply with the ACA. Support your analysis with a minimum of two peer-reviewed articles.
Using 200-300 words APA format with at least two references. Sources must be published within the last 5 years. There should be a mix between research and your reflections. Add critical thinking in the posts along with research. Apply the material in a substantial way.