Healthcare Systems, Clinical Workflows, and Regulatory Foundations for MyNursePal Inc. Developers and Designers

This module introduces developers to the structure, workflow, and daily operations of acute care in the U.S. healthcare system. Learners will explore what acute care is, who receives care, who delivers the care, and how hospital environments are organized. The module breaks down common hospital units, team roles, naming conventions, and transitions after hospitalization, giving developers a clear, practical understanding of how patients move through acute settings and what data is generated along the way. This foundational knowledge helps developers design tools that accurately mirror real hospital workflows, terminology, and care pathways.

This module introduces learners to the structure, purpose, and daily operations of long-term care (LTC) environments, where individuals who cannot safely live independently receive 24/7 support. Participants will explore the differences between skilled nursing facilities (SNFs), assisted living, memory care, traditional nursing homes, and custodial care settings, gaining clarity on the unique resident populations, clinical workflows, and interdisciplinary teams that deliver long-term support.

The module also provides an essential technical foundation for developers by detailing the LTC Nomenclature. Learners will understand how and why naming conventions differ across LTC environments and how to apply these in development.

This module provides a clear overview of long-term care (LTC) settings, including skilled nursing facilities (SNFs), assisted living, memory care, and traditional nursing homes. Learners will understand who LTC serves, the types of care provided—such as custodial care, dementia support, and rehabilitation—and the daily roles of caregivers and clinical staff.

The module also introduces the LTC naming and hierarchy system. Learners will see why consistent naming is essential for accurate documentation, reporting, and interoperability across LTC environments.

This module introduces learners to Home Health Care, a service that delivers skilled medical treatment directly in a patient’s home. Participants will explore how home health supports individuals recovering from surgery, illness, or hospitalization by providing services such as wound care, IV therapy, medication management, rehabilitation, end-of-life care, and ongoing clinical monitoring.

Learners will examine the roles of the interdisciplinary care team, including nurses, therapists, social workers, and home health aides, and gain an understanding of how home health services are distinct from both Acute Care and Home & Community-Based Services (HCBS). Emphasis is placed on home-based workflows, documentation requirements, and the daily realities of caring for patients outside of traditional healthcare facilities.

The module prepares developers to build tools that support accurate documentation, mobile fieldwork, secure data capture, role-based permissions, and efficient coordination of care delivered in the home.

This module introduces learners to Home and Community-Based Services (HCBS), a system designed to support individuals with disabilities, chronic illnesses, or developmental conditions in their own homes and communities rather than institutional settings. Participants will explore the core purpose of HCBS — promoting independence, inclusion, and quality of life—and learn about the environments where care is delivered, including individual homes, group homes, adult day programs, and adult foster care.

The module also covers essential operational components, including Medicaid-funded waiver programs, unit-based and per-diem billing models, and Electronic Visit Verification (EVV) requirements. Developers will gain insight into the documentation, compliance, and workflow demands of HCBS agencies and direct support professionals (DSPs). By the end, learners will understand how to design tools that support mobile fieldwork, state-specific billing, alignment of authorization, and secure, role-based care documentation in both U.S. and international contexts.

The U.S. healthcare system operates through multiple parallel payment models—Medicare, Medicaid, commercial insurance, and managed care—each with its own eligibility rules, reimbursement methods, coding requirements, and compliance standards. This module provides developers, designers, and healthcare professionals with a clear, structured understanding of how these systems function and why they influence nearly every aspect of clinical documentation, billing workflows, and software design. Learners will explore how Medicare's four parts work, how payer rules drive data requirements, and how payment structures impact patient journeys across different care settings. By mastering these fundamentals, participants will be better equipped to build accurate, compliant, and interoperable healthcare technology.

This course provides a comprehensive introduction to Medicaid—the United States’ joint federal–state health insurance program—and its impact on software design, healthcare operations, and billing compliance. Learners will explore how Medicaid’s unique structure influences eligibility rules, funding, service delivery models, and technical requirements for electronic billing, EVV (Electronic Visit Verification), and audit readiness.

Participants will learn how Home and Community-Based Services (HCBS) waivers work, why they are essential for community living, and how they drive documentation, authorization tracking, unit-based billing, and state-by-state variances. The course also covers EDI 837P/837I claim formats, key billing workflows, and the data elements developers must capture for Medicaid reimbursement.

This course is designed for developers, analysts, and healthcare teams working on systems like MyNursePal Pro, ensuring they can build compliant, flexible, and scalable solutions for Medicaid-funded programs.