The Centers for Medicare and Medicaid services is a federal agency within the Department of Health and Human Services in the United States that regulates nursing practices in more than 17 different provider types. The agency was initially called The Healthcare Finance Administration (HCFA). CMS was formed in 1977 after the 1965 birth of President Lyndon B. Johnson’s law that became Medicaid and Medicare (Wadhera et al., 2020). Initially, Medicare was only Part A for hospital insurance and Part B for medical insurance. In present days, this is called original Medicare, and more programs have evolved as well. Medicaid, as well as only for those receiving cash assistance but has since expanded greatly.
The agency administers Medicare programs and works in partnership with the state government to administer Medicare health insurance portability standards and the Children’s Health Insurance Program (CHIP). The CMS consequently regulates long-term care facilities and covered resident rights, quality of life, person-centered care planning, physicians’ services, and the quality of care received. In addition, CMS regulates education, staff training, infection control, and health information technology and monitors fall and hospitalization rates.
Agency’s Public Reporting of Quality Indicators
CMS regulates many different facilities and organizations; hence, it is not easy to list all its methods of pubic reporting. The agency quarterly published an MDS report based on the information collected from the records in the facilities. Annual Medicare cost reports are provided by The Cost Report Public Use Files, which includes utilization data, facility characteristics, Medicare changes and costs, and Medicare and financial settlement data.
This data and information are stored in the Healthcare Provider Cost Reporting Information System (HCRIS) (Schwartz et al., 2020). The data is updated quarterly and is available on the CMS website for public viewing. In addition, the agency makes an annual report of the Hospital Cost Report Public Use File. It is also available to the public under the cost reports section of the CMS website. Reporting these metrics to the public for more transparency in the agency is essential. People often research the reports before choosing hospitals, physicians, or nursing homes. As the reports are public, hospitals, long-term care centers, and physicians are encouraged to comply with the CMS guidelines.
How the Agency Operates
Centers for Medicare and Medicaid Services collect and analyze data and then use it to produce research reports. The agency works diligently to eliminate fraud and abuse within the healthcare system. CMS is organized around three centers to support its key functions: Center for Medicare Management (CMM), Center for Beneficiary Choices (CBC) Center for Medicaid, CHIP and Survey & Certification (CMCS) (Berwick & Gilfillan, 2021).
This agency’s organizational structure executes and facilitates the design of all studies, provides expertise in data analytics, and ensures safe environments for sharing and storing data with confidentiality. The Trusted Third Party shares and communicates data on behalf of the HFPP. The agency has a large operating system headed by the Principal Deputy Administrator for Operations, a Chief Operating Officer, and a Deputy Administrator and Chief of Staff. Over 25 centers and offices report to these heads, which CMS governs (Wadhera et al., 2020). These centers and offices range from the Office of Minority Health to the Office of Information Technology and every other office.
Impact the Agency on the Quality of Healthcare
The Centers for Medicare and Medicaid Services (CMS) has one of the most significant effects on the medical billing and coding industry that can be attributed to a single government organization. The CMS substantially impacts the pace at which medical services are rendered. As a result, it also has a significant impact on the operations of private insurance companies. In the new and shifting healthcare environment of the United States, the Centers for Medicare and Medicaid Services continues to expand into a new role as outlined in the Affordable Care Act. Primary healthcare emphasizes the fundamentals of medical care, specialized treatments, and services. It does this while simultaneously catering to the needs of patients while promoting fundamental healthcare practices. CMS has a major influence because it controls physicians and offers payment incentives and cutbacks (Power et al., 2018). Regardless of whether or not a referral is necessary, the primary focus of secondary healthcare is on the patients.
Doctors and other healthcare professionals comply with the regulations set forth by CMS concerning patient rights, electronic medical records, and any other concerns that may arise. All process aspects are tracked and recorded, including payments, treatments, and outcomes. Tertiary care is the highest level of treatment available in the medical field. This care includes advanced diagnostic equipment and facilities, specialist intensive care units, and transplantation centers. CMS checks organizational payments in this sector to ensure accurate billing and conformity with clinical quality standards.
The Centers for Medicare & Medicaid Services aim to ensure that patients get the best possible care and that nurses give it at the highest possible level. If it is determined that a facility or organization has violated these criteria, the offending institution is subject to sanctions and is asked to establish a remedial action plan. In addition, CMS members responsible for that institution or department carry out a post-implementation review to verify that the plan was successfully implemented and that each finding is made public.
Conclusion
The CMS has been a regulatory agency for over 50 years and continues to grow. The agency administers Medicare, Medicaid, and the Children’s Health Insurance Program. Public reporting is essential to ensure agency transparency, and records are made public on the CMS website. The CMS collects and analyzes data and then uses it to produce reports. As a result, the agency significantly impacts medical organizations, healthcare professionals, and patients in enhancing the quality of the healthcare system.
References
Berwick, D. M., & Gilfillan, R. (2021). Reinventing the center for Medicare and Medicaid innovation. JAMA, 325(13), 1247-1248. Web.
Power, D. V., Byerley, J. S., & Steiner, B. (2018). Policy change from the Centers for Medicare and Medicaid Services provides an opportunity to improve medical student education and recruit community preceptors. Academic Medicine, 93(10), 1448-1449. Web.
Schwartz, A. J., Clarke, H. D., Sassoon, A., Neville, M. R., & Etzioni, D. A. (2020). The clinical and financial consequences of the Centers for Medicare and Medicaid Services’ Two-Midnight Rule in total joint arthroplasty. The Journal of Arthroplasty, 35(1), 1-6. Web.
Wadhera, R. K., Figueroa, J. F., Maddox, K. E. J., Rosenbaum, L. S., Kazi, D. S., & Yeh, R. W. (2020). Quality measure development and associated spending by the Centers for Medicare & Medicaid Services. JAMA, 323(16), 1614-1616. Web.