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WGU C799 Task 1 Healthcare Ecosystems |Latest
Update with Complete Solution
College of Health Professions, Western Governors University
Date
Federal Government Payor Program
Medicare Certification
For facilities to become Medicare certified and receive reimbursement they must meet
and follow Medicare’s Conditions of Participation. These seventy-five conditions are outlined in
Title 42 Subchapter G of the Code of Federal Regulations. (Center for Medicare and Medicaid
Services [CMS] 2024) These requirements were enacted to ensure that all patients receive the
highest quality of care with the best possible outcomes and that facilities operate safely.
Accreditation and Licensing
Licensure for healthcare facilities and physicians is like that of a license to drive a car, as
they are both issued by the state of practice and are mandatory for legal operation. For facilities
to obtain a license, they are required to meet certain standards. These standards are to ensure
patient safety and quality of care. Some requirements for facilities are that they must be
appropriately staffed in all areas, as well as have properly maintained buildings and equipment.
Licensing is performed on an annual basis. (Oachs and Watters, 2020) For physicians to be
licensed, they must complete medical school, a residency program, and/or a fellowship.
(Wagner, 2020)
Accreditation for healthcare facilities is a voluntary process. Its purpose is to show that
facilities provide high-quality care by following a set of standards created by the accrediting
body. One accrediting body for healthcare facilities is the Joint Commission, whose surveys are
completed every three years. A facility that is accredited has also shown that it meets the
requirements for Medicare and Medicaid reimbursement. (Oachs and Watters, 2020)
Quality Reporting System and Reimbursement
WGU C799 Task 1 Healthcare Ecosystems |Latest
Update with Complete Solution
College of Health Professions, Western Governors University
Date
Federal Government Payor Program
Medicare Certification
For facilities to become Medicare certified and receive reimbursement they must meet
and follow Medicare’s Conditions of Participation. These seventy-five conditions are outlined in
Title 42 Subchapter G of the Code of Federal Regulations. (Center for Medicare and Medicaid
Services [CMS] 2024) These requirements were enacted to ensure that all patients receive the
highest quality of care with the best possible outcomes and that facilities operate safely.
Accreditation and Licensing
Licensure for healthcare facilities and physicians is like that of a license to drive a car, as
they are both issued by the state of practice and are mandatory for legal operation. For facilities
to obtain a license, they are required to meet certain standards. These standards are to ensure
patient safety and quality of care. Some requirements for facilities are that they must be
appropriately staffed in all areas, as well as have properly maintained buildings and equipment.
Licensing is performed on an annual basis. (Oachs and Watters, 2020) For physicians to be
licensed, they must complete medical school, a residency program, and/or a fellowship.
(Wagner, 2020)
Accreditation for healthcare facilities is a voluntary process. Its purpose is to show that
facilities provide high-quality care by following a set of standards created by the accrediting
body. One accrediting body for healthcare facilities is the Joint Commission, whose surveys are
completed every three years. A facility that is accredited has also shown that it meets the
requirements for Medicare and Medicaid reimbursement. (Oachs and Watters, 2020)
Quality Reporting System and Reimbursement
