The Impact of Medicare on Health Information Management

Junior (College 3rd year) ・Healthcare&Medicine ・APA ・2 Sources

Government health care programs such as Medicare are established to reduce the burden of illnesses, disability and injury and improve the health and enhance affordability by Americans. Medicare, as a federal government payer program provides health insurance to persons eligible for social security. Eligibility in this case refers to persons over 65 years, individuals under 65 year with specific disabilities and any other person with an end stage renal disease. The paper therefore is a discussion on how Medicare impacts on licensure, certification or accreditation standard and how it influences clinical reporting systems, reimbursement and patient access to healthcare services. The essay further focuses on effects of Medicare on responsibilities of health information management.

Health care programs and facilities have to be licensed and certified in order for them to partake in Medicare programs. Individuals or professionals must be credible and should have valid licenses before offering services in licensed and certified institutions (Troy, 2015). Hospitals that are not certified, licensed or noncompliant with regulations get terminated from the centers for Medicare. Additionally, accreditation of hospitals provides these facilities with opportunities to participate in avenues such as staff requirements, procedural provisions and reimbursement. Medicare’s regulation of compliance of codes therefore prompts institutions to be licensed, certified and accredited before beginning its operations (Paul, Honeycutt, & Colbum 2007).

Medicare directly and indirectly influences clinical quality reporting systems. The government sponsored program helps in tracking and measuring health care services provided to the targets. Quality reports undertaken ensure that the healthcare system delivers efficient, timely, equitable safe and effective services. Medicare deals with patient safety, public health, and involvement of family members in the welfare of patients. Through the provided information and analyzed data, the health care ecosystem implements policies favoring efficient of use resources, improvement of clinical process and remedying of defects in operation. Medicare centers its services on improvement of clinical quality measures through enforcing submission of organization’s information and reports (Paul, Honeycutt, & Colbum, 2007).

Medical institutions contract with Medicare to receive reimbursement. Reimbursements enable health care services to be effectively provided while accessibility is necessitated to all patients. Medicare was established to cater for the health of the aged and disabled. Americans over the age of 65 and other eligible persons compulsorily receive medical insurance. Assessment and direct care of Medicare patients is a guarantee. Conditions established for the welfare of the patients include 24 hour nursing services, staff credibility and constant utilization review (Paul, Honeycutt, & Colbum, 2007). Medicare obligates institutions to avoid unnecessary overuse of funds, misuse, and underuse of services. The non-profit based program also compensates patients in cases of negligence, misdirection and other unplanned complications. Priority on treatment outcomes, clinical efficiency and patient satisfaction is the aim of Medicare. Hospitals that have conformed to Medicare conditions consequently guarantee patient accessibility to health care services and reimbursements (Troy, 2015).

Health Information management (HIM) is responsible for maintaining and retrieving patient health information. The roles of Health Information Management are guided by state laws or federal laws (Troy 2015). HIM is expected to govern data and standardize it for the purpose of improving the quality and patient safety. Medicare has a significant impact on the role of health information management. Medicare is acknowledged for increasing the number of HIM professionals in the healthcare sector (Paul, Honeycutt, & Colbum, 2007). The increased personnel is as a result of increased responsibility in hospitals since record keeping, analysis and reporting is increasing with the better service delivery given to the public. Medicare has also standardized service delivery among professionals. Focus on quality services and eradication of discrimination and biasness has been the instrumental role of Medicare.


Paul, D.., Honeycutt, A. & Colbum. (2007). Medicare. Health Marketing Quarterly.

Troy D. (2015)How the Government as a Payer Shapes the Health Care Marketplace. American Health Poilicy Institute. Retrieved From:"

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