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HCM 345- 6-1 Discussion: Additional Regulations

Sep 9, 2023

6-1 Discussion: Additional Regulations

In your post, evaluate the purpose of recovery audit contractors (RACs) and electronic health records (EHRs), as well as the impact on either case management or performance incentives. Support your answer with course resources. In response to your peers, agree or disagree with their assessments of the effectiveness of RAC. Be sure to justify your answer.

6-1 Discussion: Additional Regulations

The program’s purpose is to offer Medicare and Medicaid providers incentives. Through this program, providers who reach predetermined CMS thresholds will receive incentive payments. The rule encourages healthcare providers to use their EHR system to boost efficiency, quality, and safety while lowering disparities in access to care (Schramm, 2012, p.47). A provider who takes part in the P4P system is paid for achieving goals.

In order to share patient records with multiple organizations, doctors are encouraged by meaningful use to upgrade the hardware and software used in their HER systems. As a result, an organization’s performance will increase, and patient satisfaction and service quality will improve. Over two years, providers must complete various stages of the incentive program. The provider is eligible for an incentive payment once all performance goals have been met.

Regulations and the record-keeping processes that go along with them play a big role in case management. These rules require greater attention to detail in terms of treatment, record-keeping, billing, etc. These regulations include involving patients and their families in their health, improving care coordination, improving population and public health, and ensuring adequate privacy and security protection for personal health information (Wager, Lee & Glaser, 2021). To guarantee that the patient is receiving the best care possible, these objectives are in line with improvements to case management practices and procedures.

These rules are designed to assist organizations in delivering top-notch care along with outstanding internal operational procedures and documentation. Providers have found the use of these regulations to strengthen operational procedures and reduce reimbursement losses. These standards encourage the adoption of EHR systems by healthcare providers (Hanauer et al. 2015, p.295). The government expects that with the adoption of widespread EHR systems, it will be able to gather information on healthcare costs and chronic health issues.


Hanauer, D. A., Mei, Q., Law, J., Khanna, R., & Zheng, K. (2015). Supporting information retrieval from electronic health records: A report of University of Michigan’s nine-year experience in developing and using the Electronic Medical Record Search Engine (EMERSE). Journal of Biomedical Informatics55, 290-300.

Schramm, M. (2012). Strategies for responding to RAC requests electronically. Healthcare financial management, 66(4), 46-49.

Wager, K. A., Lee, F. W., & Glaser, J. P. (2021). Health care information systems: a practical approach for health care management. John Wiley & Sons. 

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