1
WGU C812 Task 2: Healthcare Reimbursement | Passed on
First Attempt |Latest Update with Complete Solution
Healthcare Reimbursement C812
Task 2
Western Governors University
A1: MIPS Goals
The overall objective is to provide the best practices so the organization can establish
itself for moving toward a patient-centered quality improvement process. Support becomes
necessary to achieve this criterion through evidence and quality decision-making criteria. CMS
and the National Quality Strategy (NQS) establish strategic priorities for quality improvement,
providing organizations with the structure and guidance to follow. The goal of these strategies is
to achieve optimal health and positive health outcomes. The listed quality programs include
VBPS, HRRP, and HACRP. Within these programs, CMS and NQS have determined that these
approaches are suitable for physicians and organizations to use in achieving the applicable
required standards.
VBPS directs address performance measures such as Clinical Care, Patient- and
Caregiver-Centered Experience of care coordination, Efficiency and Cost Reduction, and Safety.
Adhering to these quality measures provides financial incentives. Secondly, The Hospital
Readmission Reduction Program (HRRP) direction addresses the improvement in care quality
with the reduction of preventable readmissions by encouraging hospitals to provide the proper
treatment during admission and discharge, along with proper follow up guidance and orders,
Organizations with a payment re0duction percentage greater than zero percent are penalized for
that fiscal year, for failing in the quality of reducing readmissions. Organizations with a payment
, 2
reduction percentage equal to zero percent are exempt from the penalty.
The Hospital-Acquired Condition Reduction Program focuses on improving patient
safety and quality, aiming to reduce preventable conditions, ranging from infections to injuries,
acquired during a hospital stay. Organizations will receive a reduction in payment as a result of
an unacceptable threshold total score percentage. Consequently, this quality measure aims
to ensure proper safety practices and adherence to best safety guidelines. (Centers for Medicare
& Medicaid Services, 2025)
MIPS's initial goal is to ensure that every patient receives optimal care and achieves
positive health outcomes. Because many patients experience health disparities, quality care with
oversight allows the patient experience to align with CMS goals. Within the measure of quality,
MIPS serves as the foundation for a health service to be effective, safe, efficient, patient-
centered, equitable, and timely. Within the quality measures, CMS has the ability to examine the
day-to-day descriptions that physicians perform, identify areas for improvement, and provide
feedback on the clinical practice's functionality. Quality is a goal of MIPS because for services to
be effective, equitable, and safe, sufficient quality must be achieved to ensure top
reimbursement. (Centers for Medicare & Medicaid Services, 2025)
Secondly, MIPS incorporates the goal of cost, which promotes efficiency by reducing
unnecessary spending and implementing a value or volume approach. Educating a clinician on
cost performance enables the provider to gain a better understanding of expenses, including
managing conditions, procedures, and hospitalization costs. Cost performance within MIPS helps
align physicians with the national median measure and performance rating benchmark.
The goal initiatives are set on rewarding care coordination, which physicians benefit from
when care coordination and high-quality patient care are delivered. This rewarding system with
cost performance aims for clinics to increase patient health outcomes and reduce readmissions.
, 3
Through these performance-based processes, physicians with lower scores are favored more than
those with higher scores, who receive lower cost incentives.
The MIPS Third Goal initiative, Promoting Interoperability, addresses the effective use of
technology to exceed the goal of interoperability by implementing the process of meaningful use
of electronic health record (EHR) systems. Interoperability enables the delivery of safe, patient-
centered care, as well as effective and accessible ways to access electronic health information
and manage and coordinate care delivery. Interoperability enables patients to have the capability
to receive and communicate with their physicians. This exchange improves patient access,
quality care outcomes, and supports the exchange of data, analysis, and health information
between providers. The use of interoperability enhances the provider's approach to the EHR
system and is used to calculate MIPS score points based on usage consistency. (Centers for
Medicare & Medicaid Services, 2025)
The fourth goal in the MIPS process is Improvement Activities. This engagement is a
continuous performance tracking tool that collects data and helps identify areas that are lacking
in enhancement within clinical or operational areas. When a healthcare physician participates in
these improvement activities, it creates better population health and improves patient experiences
and outcomes, such as patient engagement, population health, and lowering care costs, while
consistently enhancing clinician satisfaction. These supporting activities of improvement create
new operational processes to enhance clinical
practice and care delivery. When a physician chooses to select activities, it creates
alignment with their practice and the patient's needs and care. The broadness of MIPS
Improvement activities is intended to purposefully enhance clinicians' business and health equity
for patients.
WGU C812 Task 2: Healthcare Reimbursement | Passed on
First Attempt |Latest Update with Complete Solution
Healthcare Reimbursement C812
Task 2
Western Governors University
A1: MIPS Goals
The overall objective is to provide the best practices so the organization can establish
itself for moving toward a patient-centered quality improvement process. Support becomes
necessary to achieve this criterion through evidence and quality decision-making criteria. CMS
and the National Quality Strategy (NQS) establish strategic priorities for quality improvement,
providing organizations with the structure and guidance to follow. The goal of these strategies is
to achieve optimal health and positive health outcomes. The listed quality programs include
VBPS, HRRP, and HACRP. Within these programs, CMS and NQS have determined that these
approaches are suitable for physicians and organizations to use in achieving the applicable
required standards.
VBPS directs address performance measures such as Clinical Care, Patient- and
Caregiver-Centered Experience of care coordination, Efficiency and Cost Reduction, and Safety.
Adhering to these quality measures provides financial incentives. Secondly, The Hospital
Readmission Reduction Program (HRRP) direction addresses the improvement in care quality
with the reduction of preventable readmissions by encouraging hospitals to provide the proper
treatment during admission and discharge, along with proper follow up guidance and orders,
Organizations with a payment re0duction percentage greater than zero percent are penalized for
that fiscal year, for failing in the quality of reducing readmissions. Organizations with a payment
, 2
reduction percentage equal to zero percent are exempt from the penalty.
The Hospital-Acquired Condition Reduction Program focuses on improving patient
safety and quality, aiming to reduce preventable conditions, ranging from infections to injuries,
acquired during a hospital stay. Organizations will receive a reduction in payment as a result of
an unacceptable threshold total score percentage. Consequently, this quality measure aims
to ensure proper safety practices and adherence to best safety guidelines. (Centers for Medicare
& Medicaid Services, 2025)
MIPS's initial goal is to ensure that every patient receives optimal care and achieves
positive health outcomes. Because many patients experience health disparities, quality care with
oversight allows the patient experience to align with CMS goals. Within the measure of quality,
MIPS serves as the foundation for a health service to be effective, safe, efficient, patient-
centered, equitable, and timely. Within the quality measures, CMS has the ability to examine the
day-to-day descriptions that physicians perform, identify areas for improvement, and provide
feedback on the clinical practice's functionality. Quality is a goal of MIPS because for services to
be effective, equitable, and safe, sufficient quality must be achieved to ensure top
reimbursement. (Centers for Medicare & Medicaid Services, 2025)
Secondly, MIPS incorporates the goal of cost, which promotes efficiency by reducing
unnecessary spending and implementing a value or volume approach. Educating a clinician on
cost performance enables the provider to gain a better understanding of expenses, including
managing conditions, procedures, and hospitalization costs. Cost performance within MIPS helps
align physicians with the national median measure and performance rating benchmark.
The goal initiatives are set on rewarding care coordination, which physicians benefit from
when care coordination and high-quality patient care are delivered. This rewarding system with
cost performance aims for clinics to increase patient health outcomes and reduce readmissions.
, 3
Through these performance-based processes, physicians with lower scores are favored more than
those with higher scores, who receive lower cost incentives.
The MIPS Third Goal initiative, Promoting Interoperability, addresses the effective use of
technology to exceed the goal of interoperability by implementing the process of meaningful use
of electronic health record (EHR) systems. Interoperability enables the delivery of safe, patient-
centered care, as well as effective and accessible ways to access electronic health information
and manage and coordinate care delivery. Interoperability enables patients to have the capability
to receive and communicate with their physicians. This exchange improves patient access,
quality care outcomes, and supports the exchange of data, analysis, and health information
between providers. The use of interoperability enhances the provider's approach to the EHR
system and is used to calculate MIPS score points based on usage consistency. (Centers for
Medicare & Medicaid Services, 2025)
The fourth goal in the MIPS process is Improvement Activities. This engagement is a
continuous performance tracking tool that collects data and helps identify areas that are lacking
in enhancement within clinical or operational areas. When a healthcare physician participates in
these improvement activities, it creates better population health and improves patient experiences
and outcomes, such as patient engagement, population health, and lowering care costs, while
consistently enhancing clinician satisfaction. These supporting activities of improvement create
new operational processes to enhance clinical
practice and care delivery. When a physician chooses to select activities, it creates
alignment with their practice and the patient's needs and care. The broadness of MIPS
Improvement activities is intended to purposefully enhance clinicians' business and health equity
for patients.
