Documentation and Reimbursement in Nursing

Medicare is mainly based on age or disability and it is subdivided into several parts, namely, A, B, C, and D. The program is funded using a portion of the taxes collected from the incomes of the working population. The different parts of Medicare cover and pay for different health expenses. Medicaid on the other hand is income based. The recipients for Medicaid need to follow a certain criteria in relation to their medical needs, the level of their income alongside other resources. Medicaid pays for the expenses that are approved but not paid for the beneficiaries of Medicare who qualify.

Centers for Medicare & Medicaid Services payment denial have an impact on the health care system. To start with, the programs have increased the accessibility of healthcare to many. This is based on the fact that these programs provide affordable care as compared to the previous times when the programs had not been launched. The other impact of this is that it has enabled smooth transitions of payment systems. This is as a result of coordination across different providers in different settings. Effectiveness has also been enhanced since care is evidence based and driven by output. This helps in the management and prevention of diseases. The value based system has also enhanced safety and transparency. This is because the value based payment system offers information to beneficiaries based on the quality, safety and cost of their health care.

The implication to nursing practice that is related to these programs is that coordination in the nursing practice has been enhanced as well as effectiveness of the practice. The services offered by healthcare providers have also reached out to almost all the members of the society and the health of the country has generally improved.



Chapter 20 Hebda, T., & Czar, P. (2013). Handbook of informatics for nurses & healthcare professionals (5th ed.). Boston, MA: Pearson.

NR-361 Online Lesson Week 5; Standardize Terminology and Language in Informatics.



Leave a Reply