Hcs 455 The Policy Process Analysis
The Policy Process: Evaluation, Analysis, and Revision
Barbie Tucker
HCS/455
6/15/15
James McManus
There are many stages in the policy making process. In the fight of fraud and abuse of healthcare programs, Congress implemented the Health Care Fraud and Abuse Control (HCFAC) in the Health Insurance Portability and Accountability Act of 1996 (HIPAA). (GAO, 2011). Policies are always evaluated to find solutions to issues which arise in policies. The analysis done to see if the policy receives positive outcomes and detect the negative outcomes to help in the revising of the policy. The understanding of the stages in policy making can determine if the policy will be a success or a failure which the policy may be terminated all …show more content…
together. The fraud and abuse policy in healthcare is no exception when hitting the stages of evaluation, analysis, and revise.
Evaluation
The evaluation stage is to use research methods to find the effectiveness of the policy. It is to determine the merit, worth, or value which will determine the improvements of social and economic conditions of stakeholders. (CDC, 2012). Evaluation stage will help in understanding the impact of the policy it had when implemented. There are six steps in evaluation of a policy which are: engaging stakeholders, describing the program or policy, focusing the evaluation, gather credible evidence, justify conclusions, and ensure use and share lessons learned. There are four categories in conducted an evaluation which are utility, feasibility, propriety, and accuracy.
There are similarities in policy evaluation and program evaluation such as the level of analysis required, degree of control and clear boundaries, ability to identify, scale and scope of data, type and number of stakeholders but policy evaluation will need more emphasis on the use of surveillance and administrative data. (CDC, 2012). There are different types of evaluation and more than may be needed in evaluating the policy. These types are evaluating policy content, evaluating policy implementation, and evaluating policy impact. The evaluating policy impact would be vital to the fraud and abuse policy because it would help in showing the decrease or increase of fraud and abuse in the health care industry. Although, the other two would also be appropriate because of the understanding of the need of the policy and the implementation that needs to be placed for better outcomes in the economics. The use of the appropriate design, indicators, and methods challenges can be solved in the policy evaluation. It is critical to have the evaluation stage in a policy to determine solutions to challenges which arise and to implement better regulations for positive outcomes.
Analysis
The analysis stage is where the decisions about how the analysis will be done, the sources of information which will be used, and how the stakeholders will be involved in the policy. In the analysis stage, there stages must be obtained to have a final analysis of the policy.
The initiation is the first stage which are creative thoughts about the problem. Then the definition of the objective, designing options, exploration of concepts, and claims and possibilities.
The second stage is estimation which is accomplished by investigating concepts and claims through scientific examination.
The third stage is the selection where the debating of possible options are to be chosen, compromised, bargained, and accommodated. The reducing of the uncertainty of options, decisions among the options, and assignment of executive responsibility which are pondered over in this stage.
The fourth stage is the implementation which is the crucial stage of the process because of the involvement of the rules, regulations, and guidelines which must be carried out in the policy. This stage will determine the decisions to be made to achieve the goal and standards of the policy.
The fifth stage is the evaluation which is expected to have comparisons of actual performance levels as well as the assignment of responsibility to discover discrepancies in the performance.
The sixth stage is the termination which is the final stage of the analysis stage. It focuses on the costs, consequences, and benefits for reductions or closures. (GAO, 2011). The factors in what would make the fraud and abuse policy from being achieved is the increase of health care fraud and abuse.
The continuance of misrepresentation of services with incorrect CPT codes, billing services not rendered, altering claim forms for higher payments, falsification of information on forms, misrepresentation of services that was not performed or the type of service, billing for not supplies used, and providing medical services that are not needed these performances will cost the taxpayer money as well as the government. To meet the objective of the fraud and abuse policy is difficult because of the lack of detecting the crime. To help in the decreasing of the fraud and abuse there has been more enforcement of the False Claims Act of 1986 which as of 2007 there has been over $11.2 billion dollars collected in fraudulent claims. The increased of surveillance has resulted in a positive outcome of health care savings of $39 billion dollars. (AHIMA, …show more content…
2008).
Revision
The revision stage is where complied data has been analyzed and the already written policy needs to have changes for better outcomes of the policy implementation. In the fraud and abuse policy there was sufficient data to revise the policy with the False Claims Act and the Health Care Fraud and Abuse Control as a part of the HIPAA Act. The Whistleblower Act has also been revise in some of the state policies to combat fraud and abuse. The Anti-Kickback Statue has also been implement in the health care reform to help in the combating of fraud and abuse. (Health Reform GPS, 2010). The fraud and abuse policy includes the health care industry with the undetected Medicare/ Medicaid crimes. (GAO, 2011).
There are other ways to help in detection of fraud and abuse in the health care industry with education and training, implementation of computer-assisted coding (CAC), the continuing increase of federal enforcement, and use of data modeling and data mining.
These could be implanted in the fraud and abuse policy where health care facilities will have to abide by the regulation to decrease the chance of fraud and abuse in the health care industry. Although there are policies for different agendas not all are maintain as policies.
They can be terminated if the data does not support the policy or failure to have revisions done to solve the problems. The continuance of combating fraud and abuse must be a teamwork effort of physicians, health care provider, organizational, and federal levels. The responsibility, ownership, and consequences for actions should be frequently communicated to the health care industry for more positive outcomes of reducing fraud and
abuse.
References
Health Care Fraud and Abuse. 2011. Perspectives Health Information Management. AHIMA Foundation: Research and Education in HIM. Retrieved by http://perspectives.ahima.org/healthcare-fraud-abuse/
Health Care Fraud and Abuse Control Program. 2011. Retrieved by http://www.gao.gov/products/GAO-11-446
CDC. 2012. Overview of Policy Evaluation retrieved by http://www.cdc.gov
Fraud and Abuse: Revisions to Anti-Kickback Statue. 2010. Health Reforms GPS retrieved by http://www.healthreformgps.org/resources/fraud-and-abuse-revisions-to-anti-kickback-statute/
Barbie Tucker
HCS/455
6/15/15
James McManus
There are many stages in the policy making process. In the fight of fraud and abuse of healthcare programs, Congress implemented the Health Care Fraud and Abuse Control (HCFAC) in the Health Insurance Portability and Accountability Act of 1996 (HIPAA). (GAO, 2011). Policies are always evaluated to find solutions to issues which arise in policies. The analysis done to see if the policy receives positive outcomes and detect the negative outcomes to help in the revising of the policy. The understanding of the stages in policy making can determine if the policy will be a success or a failure which the policy may be terminated all …show more content…
together. The fraud and abuse policy in healthcare is no exception when hitting the stages of evaluation, analysis, and revise.
Evaluation
The evaluation stage is to use research methods to find the effectiveness of the policy. It is to determine the merit, worth, or value which will determine the improvements of social and economic conditions of stakeholders. (CDC, 2012). Evaluation stage will help in understanding the impact of the policy it had when implemented. There are six steps in evaluation of a policy which are: engaging stakeholders, describing the program or policy, focusing the evaluation, gather credible evidence, justify conclusions, and ensure use and share lessons learned. There are four categories in conducted an evaluation which are utility, feasibility, propriety, and accuracy.
There are similarities in policy evaluation and program evaluation such as the level of analysis required, degree of control and clear boundaries, ability to identify, scale and scope of data, type and number of stakeholders but policy evaluation will need more emphasis on the use of surveillance and administrative data. (CDC, 2012). There are different types of evaluation and more than may be needed in evaluating the policy. These types are evaluating policy content, evaluating policy implementation, and evaluating policy impact. The evaluating policy impact would be vital to the fraud and abuse policy because it would help in showing the decrease or increase of fraud and abuse in the health care industry. Although, the other two would also be appropriate because of the understanding of the need of the policy and the implementation that needs to be placed for better outcomes in the economics. The use of the appropriate design, indicators, and methods challenges can be solved in the policy evaluation. It is critical to have the evaluation stage in a policy to determine solutions to challenges which arise and to implement better regulations for positive outcomes.
Analysis
The analysis stage is where the decisions about how the analysis will be done, the sources of information which will be used, and how the stakeholders will be involved in the policy. In the analysis stage, there stages must be obtained to have a final analysis of the policy.
The initiation is the first stage which are creative thoughts about the problem. Then the definition of the objective, designing options, exploration of concepts, and claims and possibilities.
The second stage is estimation which is accomplished by investigating concepts and claims through scientific examination.
The third stage is the selection where the debating of possible options are to be chosen, compromised, bargained, and accommodated. The reducing of the uncertainty of options, decisions among the options, and assignment of executive responsibility which are pondered over in this stage.
The fourth stage is the implementation which is the crucial stage of the process because of the involvement of the rules, regulations, and guidelines which must be carried out in the policy. This stage will determine the decisions to be made to achieve the goal and standards of the policy.
The fifth stage is the evaluation which is expected to have comparisons of actual performance levels as well as the assignment of responsibility to discover discrepancies in the performance.
The sixth stage is the termination which is the final stage of the analysis stage. It focuses on the costs, consequences, and benefits for reductions or closures. (GAO, 2011). The factors in what would make the fraud and abuse policy from being achieved is the increase of health care fraud and abuse.
The continuance of misrepresentation of services with incorrect CPT codes, billing services not rendered, altering claim forms for higher payments, falsification of information on forms, misrepresentation of services that was not performed or the type of service, billing for not supplies used, and providing medical services that are not needed these performances will cost the taxpayer money as well as the government. To meet the objective of the fraud and abuse policy is difficult because of the lack of detecting the crime. To help in the decreasing of the fraud and abuse there has been more enforcement of the False Claims Act of 1986 which as of 2007 there has been over $11.2 billion dollars collected in fraudulent claims. The increased of surveillance has resulted in a positive outcome of health care savings of $39 billion dollars. (AHIMA, …show more content…
2008).
Revision
The revision stage is where complied data has been analyzed and the already written policy needs to have changes for better outcomes of the policy implementation. In the fraud and abuse policy there was sufficient data to revise the policy with the False Claims Act and the Health Care Fraud and Abuse Control as a part of the HIPAA Act. The Whistleblower Act has also been revise in some of the state policies to combat fraud and abuse. The Anti-Kickback Statue has also been implement in the health care reform to help in the combating of fraud and abuse. (Health Reform GPS, 2010). The fraud and abuse policy includes the health care industry with the undetected Medicare/ Medicaid crimes. (GAO, 2011).
There are other ways to help in detection of fraud and abuse in the health care industry with education and training, implementation of computer-assisted coding (CAC), the continuing increase of federal enforcement, and use of data modeling and data mining.
These could be implanted in the fraud and abuse policy where health care facilities will have to abide by the regulation to decrease the chance of fraud and abuse in the health care industry. Although there are policies for different agendas not all are maintain as policies.
They can be terminated if the data does not support the policy or failure to have revisions done to solve the problems. The continuance of combating fraud and abuse must be a teamwork effort of physicians, health care provider, organizational, and federal levels. The responsibility, ownership, and consequences for actions should be frequently communicated to the health care industry for more positive outcomes of reducing fraud and
abuse.
References
Health Care Fraud and Abuse. 2011. Perspectives Health Information Management. AHIMA Foundation: Research and Education in HIM. Retrieved by http://perspectives.ahima.org/healthcare-fraud-abuse/
Health Care Fraud and Abuse Control Program. 2011. Retrieved by http://www.gao.gov/products/GAO-11-446
CDC. 2012. Overview of Policy Evaluation retrieved by http://www.cdc.gov
Fraud and Abuse: Revisions to Anti-Kickback Statue. 2010. Health Reforms GPS retrieved by http://www.healthreformgps.org/resources/fraud-and-abuse-revisions-to-anti-kickback-statute/