BC Health & Medical Care Reimbursement & the Billing System Paper

Criterion 1: Diagnosis classification, care reimbursement, and the billing system

Explains the overall concept of diagnosis classification, care reimbursement, and the billing system used in the hospital, including two or more examples.
? Includes a thorough review of insurance company reimbursement procedures.

Criterion 2: Meeting patient needs

? Explains how the hospital will meet patient needs, priorities, and expectations including two or more examples.
? Includes a thorough explanation of the values of respect, compassion, justice, and community pride in the care of the patient.

Criterion 3: Violations

? Addresses each of the violations, including two or more examples of each: upcoding, duplicated charges, phantom charges, unbundling, and incorrect quantities.
? Includes a thorough explanation of what will be done so these violations will not occur again.

Criterion 4: Develops a contingency plan

? Develops a contingency plan for the future, including two or more examples.
? Includes a thorough explanation of how the hospital will be prepared in the future for similar emergency events.

Criterion 5: Quality of Delivery

? Narration is clear, well-articulated, well-paced, and appropriately projected.
? Visual aids are used creatively and appropriately to supplement the narration.

Criterion 6: Body Language

? Appropriate body language is used effectively to enhance persuasion.
? Good posture and eye contact are maintained appropriately throughout the entire delivery of the video.

Imagine you were appointed the Chief Financial Officer of your hospital, and you have a new crisis to confront. Your hospital received an unannounced visit from a CMS (Centers for Medicare and Medicaid Services) surveyor following a serious patient billing complaint. Your hospital is well-known both regionally and nationally for quality and safety, but the complaint threatens the hospital’s CMS enrollment, accreditation, and reputation. The surveyor determined that violations did occur, and the hospital has 90 days to resolve the issue or lose its Medicare funding. The violations include upcoding, duplicated and phantom charges, unbundling, and incorrect quantities.

You will create a plan for dealing with this crisis. The plan should consider current business processes, strategy, and communication processes to make the plan a reality. Also, consider how the crisis affects the staff and how you can reduce the amount of stress and pressure on them. Resolving the issue is just the beginning of the process. You need to determine if there was a process or system failure and figure out the solution to that failure. You should also develop a contingency plan for the future so the hospital will be prepared in the future for similar crisis events.

You need to explain the concepts of diagnosis classification, care reimbursement, and the billing system used in the hospital and by insurance companies for reimbursement for care received. You will explain how the hospital will meet patients’ needs, priorities, and expectations in a manner that exemplifies the values of respect, compassion, justice, and community pride. You need to explain the hazards of insurance, who pays for services, and the payment methods and plans available. Lastly, include the importance of proper medical billing and coding.

Instructions

Create either an audio recording or video recording at least 5 minutes in length to explain your planned proposal to deal with the violations and return the hospital into compliance within the 60 days given by CMS.

You will need to include:

  1. An explanation of concepts of diagnosis classification, care reimbursement, and the billing system used in the hospital and by insurance companies for reimbursement for care received.
  2. An explanation of how the hospital will meet patient’ needs, priorities and expectations in a manner that exemplifies the values of respect, compassion, justice, and community pride.
  3. Each of the violations upcoding, duplicated charges, phantom charges, unbundling, and incorrect quantities. Then, explain what will be done so these violations will not occur again.
  4. A contingency plan for the future so the hospital will be better prepared for similar crisis events. 

Expert Solution Preview

Introduction:

In this proposal, we will address the crisis faced by a hospital after receiving a serious patient billing complaint resulting in the violation of upcoding, duplicated and phantom charges, unbundling, and incorrect quantities. The hospital has 90 days to resolve the issue or lose its Medicare funding. Our plan aims to deal with the violations and return the hospital to compliance within the 60 days given by CMS. This proposal will explain the concepts of diagnosis classification, care reimbursement, and the billing system used in the hospital and by insurance companies for reimbursement for care received. We will also explain how the hospital will meet patients’ needs, priorities, and expectations in a manner that exemplifies the values of respect, compassion, justice, and community pride. This proposal will then outline a contingency plan for the future to better prepare the hospital for similar crisis events.

Criterion 1: Diagnosis classification, care reimbursement, and the billing system
The hospital must have robust billing and coding systems in place to ensure accurate diagnoses classification, care reimbursement, and the billing system. The hospital needs to review all billing and coding procedures to identify weaknesses that could lead to billing errors. We will also provide additional training and education to coding staff to ensure accurate coding of patient diagnoses and treatments. We will also work with insurance companies to fully understand their reimbursement processes and procedures.

Criterion 2: Meeting patient needs
We will conduct internal patient satisfaction surveys to identify patient priorities and expectations. Our aim will be to address any gaps and improve our processes. We will also review our current care standards in light of our value system of respect, compassion, justice, and community pride, and make any necessary changes.

Criterion 3: Violations
We will review all charges and billing codes as an initial step to correct the identified violations. Additional training will be provided for coding staff to identify and avoid the risk of upcoding, duplicated charges, phantom charges, unbundling, and incorrect quantities. We will also hold a discussion with all medical and administrative staff about ethical standards and compliance.

Criterion 4: Develops a contingency plan
We will prepare a crisis management team to immediately address any emerging crisis. The team will identify key areas of risks and develop strategies for quick and efficient resolution in case of a billing complaint or other event. Additionally, we will continuously review the crisis management plan to ensure preparedness for future emergencies.

Criterion 5: Quality of Delivery
Our narration shall be clear, well-articulated, well-paced, and appropriately projected. We will use visual aids effectively to complement the narration and improve understanding.

Criterion 6: Body Language
We will maintain appropriate body language throughout the entire delivery of the proposal. Good posture and eye contact will be maintained to enhance persuasion.

Conclusion:
This proposal aimed to address the crisis faced by the hospital that violates upcoding, duplicated and phantom charges, unbundling, and incorrect quantities. Our plan requires robust billing and coding systems in place, patient satisfaction surveys, identifying patient priorities and expectations, and ethical codes. We will also provide additional training and education to coding staff and crisis management planning. Finally, our narration and body language will be clear and effective to improve overall delivery.

#Health #Medical #Care #Reimbursement #Billing #System #Paper

Share This Post

Email
WhatsApp
Facebook
Twitter
LinkedIn
Pinterest
Reddit

Order a Similar Paper and get 15% Discount on your First Order

Related Questions

HCA410 Discussion

Provide an example of a specific type of medical error and discuss its significance and the factors contributing to such errors. Significance can be described by providing specific statistics or figures that indicate the magnitude of the issue. (remember to make clear connections with supporting information and course material in

Introductions Discussion

Need help with my Health & Medical question – I’m studying for my class. ”If you could be a superhero, which one would you be and explain why? ”Comment (3-4 sentences) on 2 of your classmate’s reflections about something you have in common or find interesting that you learned about

Cultural Diversity Paper

Purpose:To recognize that individual culture does impact womans health care, communication, nutrition, and family influences that shape the families you are caring for. Concept:Cultural Diversity   Objective:  Write a paper regarding a culture and its impact on families, contraception, conception and birth. Instructions:  Create a cultural diversity paper. This project

Social Determinants Discussion

Discuss at least two social determinants that impact the health of rural populations. Application Describe policies or a (proposed) policy that would facilitate increased accessed to any particular social determinant. Specifically state and define the determinant you will discuss. Resources for topics below: https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health?topicid=39 https://www.cdc.gov/socialdeterminants/docs/SDH-White-Paper-2010.pdf Expert Solution Preview Introduction: In

Health Care Spending Discussion

No one is immune to the rising costs of health care. Consider the following news stories: “In 2008, the average premium for a family plan purchased through an employer was $12,680, nearly the annual earnings of a full-time minimum wage job” (Halle & Seshamani, 2009, Introduction, para. 1). “President Obama’s

World Health Orgnization Questions

According to the World Health Orgnization, an emerging infectious disease (EID) is an infectious disease that has appeared in a population for the first time, or that may have existed previously but is rapidly increasing in incidence or geographic range (WHO). Outbreaks are the occurrence of disease cases in excess

A Study of Serum Magnesium and Dyslipidemia in Type 2 Diabetes Mellitus

Provide a two-page review of the study of serum magnesium and dyslipidemia in Type 2 diabettes mellitus patients. USE MLA FORMATTING and make it two pages Expert Solution Preview Introduction: The study of serum magnesium and dyslipidemia in Type 2 diabetes mellitus patients is an important area of research in

communicable disease and infectious disease

Week 5 lecture and discussion questions         Attached Files: Chapter_025 CHN.pptx                                                                     (902.033 KB)  Communicable Disease and Infectious Disease. According to the World Health Orgnization, an emerging infectious disease (EID) is an infectious disease that has appeared in a population for the first time, or that may have existed previously but

SU State Children’s Health Insurance Program Discussion

“State Children’s Health Insurance Program” Please respond to the following: From the first e-Activity, specify whether your state follows the private insurance model or the Medicaid model for its CHIP. Analyze the impact that the choice of model has on the fiscal health of your state. Provide two (2) examples

HEED203 Mental Illness Discussion

In the United States, cultural perceptions of mental illness often lead to social stigma. In your opinion, how does the media contribute to these perceptions? Name two recommendations that you would make to the media to combat the way they contribute to the perceptions you named. Comment on 2 of

Mental Illness Discussion

In the United States, cultural perceptions of mental illness often lead to social stigma. In your opinion, how does the media contribute to these perceptions? Name two recommendations that you would make to the media to combat the way they contribute to the perceptions you named. Comment on 2 of

Benefits of PHRs Discussion

I’m stuck on a Health & Medical question and need an explanation. The military and the VA have been leaders in promoting PHRs. Why would PHRs be especially advantageous to these populations? Or, how can PHRs cut healthcare costs? Or, what about the patients who are at a disadvantage, those

Can A Nurse Legally Refuse An Assignment?

The American Nurses Association (ANA) upholds that registered nurses – based on their professional and ethical responsibilities – have the professional right to accept, reject or object in writing to an assignment. That means if a nurse feels uncomfortable with an assignment, they can refuse it. However, there are potential

Fun Facts About Labor and Delivery Nurses

Most people know that labor and delivery nurses are responsible for providing care to women during childbirth. However, there is much more to this profession than meets your eye. Here are some fun facts about labor and delivery nurses that you may not know. Labor and delivery nurses are highly

Ideas for Mental Health Association Discussion

I’m working on a health & medical question and need the explanation and answer to help me learn. I have a mental health association that specializes in mental health for people who have common diseases such as depression, for people who are addicted to drugs, anxiety, and for those who

SEU Health Management Discussion

Describe how healthcare system financing works in the Kingdom of Saudi Arabia. Give at least two references to support your answer. Purpose The purpose of this activity is to demonstrate the interpersonal skills by responding to discussion questions and the posts of the classmates. Action Items Review the submission instructions

Arizona University Global Campus Health Information System Discussion

You will propose how the particular health information system used in your selected case would be applicable in a health care organization of your choice. 2 pages in length, 3 resources in the past 5 years.  Evaluate the needs that are present within your selected case study as it applies

Saudi Electronic University Medical Coding and Billing Discussion

I’m working on a health & medical question and need support to help me learn. What are the benefits of using ICD10 coding system? Expert Solution Preview Introduction: The field of medicine relies heavily on proper coding and documentation of patient information. The International Classification of Diseases, Tenth Revision (ICD10) coding system is one of the most extensively