Case#1 To summarize, the report states, ‘Louisiana made incorrect Medicaid electronic health record incentive payments totaling $4.4 million. Incorrect payments included both overpayments and underpayments, for a net overpayment of $1.8 million’ (Department of Health and Human Services, Office of Inspector General, 2014c, p. i). Then the report further notes: WHY WE DID THIS REVIEW: To improve the quality and value of American health care, the Federal Government promotes the use of certified electronic health record (EHR) technology by health care professionals (professionals) and hospitals (collectively, ‘providers’). As an incentive for using EHRs, the Federal Government is making payments to providers that attest to the ‘meaningful use’ of EHRs. The Congressional Budget Office estimates that from 2011 through 2019, spending on the Medicare and Medicaid EHR incentive programs will total $30 billion; the Medicaid EHR incentive program will account for more than a third of that amount, or about $12.4 billion. The Government Accountability Office has identified improper incentive payments as the primary risk to the EHR incentive programs. These programs may be at greater risk of improper payments than other programs because they are new and have complex requirements. Other U.S. Department of Health and Human Services, Office of Inspector General, reports describe the obstacles that the Centers for Medicare and Medicaid Services (CMS) and States face overseeing the Medicare and Medicaid EHR incentive programs. The obstacles leave the programs vulnerable to paying incentive payments to providers that do not fully meet requirements. The Louisiana Department of Health and Hospitals (State agency) was one of the first State agencies to pay incentive payments, making approximately $93 million in Medicaid EHR incentive program payments during calendar year (CY) 2011. The objective of this review was to determine whether the State agency made Medicaid EHR incentive program payments in accordance with Federal and State requirements. BACKGROUND: The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009, P.L. No. 111-5, established Medicare and Medicaid EHR incentive programs to promote the adoption of EHRs. Under the HITECH Act, State Medicaid programs have the option of receiving from the Federal Government 100 percent of their expenditures for incentive payments to certain providers. The State agency administers the Medicaid program and monitors and pays EHR incentive payments. To receive an incentive payment, eligible providers attest that they meet program requirements by self-reporting data using the CMS National Level Repository (NLR). The NLR is a provider registration and verification system that contains information on providers participating in the Medicaid and Medicare EHR incentive programs. To be eligible for the Medicaid EHR incentive program, providers must meet Medicaid patient-volume requirements. In general, patient volume is calculated by dividing the provider’s total Medicaid patient encounters by the provider’s total patient encounters. For hospitals, patient encounters are defined as discharges, not days spent in the hospital (bed-days). The amount of an incentive payment depends on the type of provider. Hospitals may receive annual incentive payments that are based on a formula that consists of two main components—the overall EHR amount and the Medicaid share. Professionals receive a fixed amount of $21,250 in the first year and $8,500 in subsequent years; the total may not exceed $63,750 over a 6-year period. HOW WE CONDUCTED THIS REVIEW: From January 1 through December 31, 2011, the State agency paid $93,394,502 for Medicaid EHR incentive payments. We (1) reconciled both professional and hospital incentive payments reported on the State’s Form CMS-64, Quarterly Medicaid Assistance Expenditures for the Medical Assistance Program (CMS-64 report), with the NLR and (2) selected for further review all of the 25 hospitals that received an incentive payment totaling $1 million or more. The State agency paid the 25 hospitals $53,180,619, which is 57 percent of the total paid during CY 2011 for first-year payments. In addition, the State agency made second-year payments to 15 of the 25 hospitals, totaling $14,512,894 as of June 30, 2013. WHAT WE FOUND: The State agency did not always pay EHR incentive payments in accordance with Federal and State requirements. The State agency made incorrect EHR incentive payments to 20 hospitals totaling $4,431,518. Specifically, the State agency overpaid 13 hospitals a total of $3,090,946 and underpaid 6 hospitals a total of $1,340,572 for a net overpayment of $1,750,374. The State agency made an incorrect payment to an additional hospital; however, we confirmed that the payment had been recovered during our audit. Additionally, the State agency did not ensure that hospitals correctly calculated patient volume for 24 hospitals, made incorrect incentive payments to 13 professionals for a total overpayment of $3,250, and did not report 13 professional incentive payments to the NLR. These errors occurred because (1) State agency instructions on the hospital incentive payment and patient-volume calculations were incorrect or lacked needed information, (2) the hospital calculation worksheet had an error in the formula used to calculate the discharge-related amounts, (3) State agency personnel did not use the correct cost report periods or review supporting documentation for the numbers provided in the cost reports that were used to calculate incentive payments, (4) State agency personnel made clerical errors, (5) the State agency did not have system edits in place to prevent overpayments to professionals, and (6) the State agency did not reconcile the CMS-64 report with the NLR. (Department of Health and Human Services, Office of Inspector General, 2014c, pp. i–ii). For this case study address the following: Summarize the information presented in this Case Study. Recommend what should be done based on the results of the study Case #2 WHY WE DID THIS STUDY: Recovery Audit Contractors (RAC) are designed to protect Medicare by identifying improper payments and referring potential fraud to the Centers for Medicare and Medicaid Services (CMS). Prior Government Accountability Office work has identified problems with CMS’s actions to address improper payment vulnerabilities, and prior Office of Inspector General (OIG) work has identified problems with CMS’s actions to address referrals of potential fraud. Further, OIG has identified vulnerabilities in CMS’s oversight of its contractors. Given the critical role of identifying improper payments, effective oversight of RAC performance is important. HOW WE DID THIS STUDY: We collected RAC Data Warehouse (i.e., electronic database) files from CMS and data from RACs to determine their activities to identify improper payments and refer potential fraud in fiscal years (FYs) 2010 and 2011. We also collected data from CMS regarding activities to address vulnerabilities (i.e., improper payments exceeding $500,000 that result from a specific issue) and referrals of potential fraud. Finally, we collected RAC performance evaluations and performance evaluation metrics from CMS and determined the extent that RAC performance evaluations addressed these metrics. We also compared performance evaluation metrics to contract requirements to determine the extent that these metrics addressed contract requirements. WHAT WE FOUND: In FYs 2010 and 2011, RACs identified half of all claims they reviewed as having resulted in improper payments totaling $1.3 billion. CMS took corrective actions to address the majority of vulnerabilities it identified in FYs 2010 and 2011; however, it did not evaluate the effectiveness of these actions. As a result, high amounts of improper payment may continue. Additionally, CMS did not take action to address the six referrals of potential fraud that it received from RACs. Finally, CMS’s performance evaluations did not include metrics to evaluate RACs’ performance on all contract requirements. (Department of Health and Human Services, Office of Inspector General, 2013b, Executive summary, paras. 1–3) For this case study address the following: Summarize the information presented in this Case Study. Compose a recommendation to CMS for complying with the findings of this study. Please note: The case studies should be clearly labeled and combined into one document for submission. Each individual case study should meet the requirements listed above and should collectively be between 800 to 1,000 words in length, excluding the title and reference pages, and formatted according to APA guidelines as outlined in the Writing Center. The Chapter 12 Case Study: Electronic Health Records and Chapter 14 Case Study: Recovery Audit Contractor and Fraud Reporting paper

Mastering the Art of Online Learning: Your Guide to Acing Online Courses

Introduction

In recent years, the popularity of online courses has skyrocketed, offering learners the flexibility to acquire new skills and knowledge from the comfort of their homes. However, succeeding in online courses requires a different approach compared to traditional classroom settings. To help you make the most of your online learning experience, this article presents essential strategies and tips to ace your online courses.

1. Set Clear Goals and Plan Ahead

Before embarking on an online course, establish clear goals and objectives. Determine what you hope to achieve by the end of the course and break down your goals into manageable milestones. Create a study schedule that aligns with your other commitments, ensuring you allocate dedicated time for coursework, assignments, and revision.

2. Create a Productive Study Environment

Establishing a conducive study environment is crucial for online learning success. Find a quiet, well-lit space where you can concentrate without distractions. Remove any potential interruptions, such as notifications from social media or email. Organize your study materials and have a reliable internet connection to ensure seamless access to course materials.

3. Actively Engage in the Course

Active participation is key to mastering online courses. Engage with course materials, including videos, readings, and interactive components. Take comprehensive notes, highlighting key concepts and ideas. Participate in discussion boards, forums, and virtual meetings to interact with instructors and peers, fostering a sense of community and enhancing your understanding of the subject matter.

4. Manage Your Time Effectively

Online courses offer flexibility, but it’s essential to manage your time wisely to avoid falling behind. Create a detailed schedule, allocating specific time slots for coursework, assignments, and studying. Break down larger tasks into smaller, manageable segments to prevent procrastination. Prioritize tasks based on deadlines and dedicate focused time to each one, ensuring consistent progress throughout the course.

5. Develop Effective Communication Skills

Online courses often rely on written communication, making it crucial to hone your skills in this area. Be concise and clear in your written responses, paying attention to grammar and spelling. Actively participate in discussions, asking thoughtful questions and providing constructive feedback to your peers. Regularly check your course emails and notifications, ensuring you stay updated with any important announcements or changes.

6. Utilize Available Resources

Take full advantage of the resources provided by your online course platform and instructors. Familiarize yourself with the learning management system (LMS) and explore its features. Access supplementary materials, such as textbooks, lecture slides, and external resources recommended by instructors. Utilize online libraries, research databases, and tutorial services to deepen your understanding of the subject matter.

7. Stay Motivated and Engaged

Maintaining motivation throughout an online course can be challenging, particularly when faced with competing priorities or a lack of face-to-face interaction. Set short-term goals and reward yourself upon their completion. Connect with fellow learners through virtual study groups or online forums to foster a sense of camaraderie. Regularly remind yourself of the benefits and personal growth associated with completing the course successfully.

8. Seek Support and Clarification

Don’t hesitate to seek support or clarification when needed. Reach out to your instructors for guidance or clarification on course material. Utilize online discussion forums to ask questions or engage in collaborative problem-solving. Leverage the support services provided by your course platform or institution, such as technical support or academic advising.

Conclusion

Online courses present unique opportunities for self-paced learning and personal growth. By setting clear goals, creating a productive study environment, actively engaging with course materials, and managing your time effectively, you can maximize your chances of acing online courses. Remember to stay motivated, seek support when needed, and make the most of the available resources. Embrace the flexibility and adaptability of online learning to achieve your educational goals.