1
WGU C799 WFM1 Task 1: Federal
Government Payer Program
Medicare
, 2
Federal Government Payer Program
The provision of healthcare services is affected by many external forces such as
government regulations, accreditation standards, and federal laws.
A. Medicare Certification
According to Oachs and Watters (2020), certification is defined as “the process by which
government and nongovernment organizations evaluate educational programs, healthcare
facilities, and individuals as having met predetermined standards.” While certification of
healthcare facilities is state responsibility, certain facilities that are accredited by the Joint
Commission and the American Osteopathic Association (AOA) must be compliant with
Medicare (federal government) conditions of participation for hospitals. This affects healthcare
delivery because organizations that comply with these conditions of participation are providing
healthcare that meets high performance standards set by the federal government. The quality
measures set by the Centers for Medicare and Medicaid Services (CMS) continue to be refined
as proof of CMS’s continuing commitment to quality (Oachs & Watters, 2020).
A1. Accreditation and Licensing
Accreditation is a voluntary process. It is a review of an entity conducted by an
independent group to evaluate an organization’s work quality. These accreditation entities are
responsible for creating medical care and quality standards and determining which healthcare
organizations meet those standards. Providers choose to go through this process to validate they
are meeting appropriate standards of care. When an organization meets Joint Commission
standards, that accreditation lasts for up to three years. Licensing is a legal endorsement for a
facility to function or for a provider to practice. While accreditation is voluntary, state licensure
WGU C799 WFM1 Task 1: Federal
Government Payer Program
Medicare
, 2
Federal Government Payer Program
The provision of healthcare services is affected by many external forces such as
government regulations, accreditation standards, and federal laws.
A. Medicare Certification
According to Oachs and Watters (2020), certification is defined as “the process by which
government and nongovernment organizations evaluate educational programs, healthcare
facilities, and individuals as having met predetermined standards.” While certification of
healthcare facilities is state responsibility, certain facilities that are accredited by the Joint
Commission and the American Osteopathic Association (AOA) must be compliant with
Medicare (federal government) conditions of participation for hospitals. This affects healthcare
delivery because organizations that comply with these conditions of participation are providing
healthcare that meets high performance standards set by the federal government. The quality
measures set by the Centers for Medicare and Medicaid Services (CMS) continue to be refined
as proof of CMS’s continuing commitment to quality (Oachs & Watters, 2020).
A1. Accreditation and Licensing
Accreditation is a voluntary process. It is a review of an entity conducted by an
independent group to evaluate an organization’s work quality. These accreditation entities are
responsible for creating medical care and quality standards and determining which healthcare
organizations meet those standards. Providers choose to go through this process to validate they
are meeting appropriate standards of care. When an organization meets Joint Commission
standards, that accreditation lasts for up to three years. Licensing is a legal endorsement for a
facility to function or for a provider to practice. While accreditation is voluntary, state licensure
