Reimbursement

On October 1, 2008, The Centers for Medicare and Medicaid Services (CMS) implemented a new regulation, which deny payment for selected 10 conditions occurring during the hospital stay and are not present on admission. Out of these 10 hospital-acquired conditions, three of them were healthcare-associated infections, which are a common, expensive, and often preventable. According to an article published in Med Care on 2010, this policy was the first significant step to move output-based inpatient…

afford the assistance and care needed to remain healthy and safe. Medicare and Medicaid do not pay for custodial care (ADL assistance, non-nursing care). Also mental health Medicare and more particularly Medicare “assignment” plans greatly limit reimbursement for mental health services. There are some programs available in the community to assist the elderly, but some are not widely known to the population. Many elderly have slightly too much income and/or assets to qualify for Medicaid,…

the first year of working there is no compensation for study hours, material, or exam cost. However, if I do take an exam and pass, would it is reasonable to ask for reimbursement of the exam total cost? Also with that said, I figured it be worth asking since I will be signing my contact this week, would I be able to get reimbursement for the exam I am taking next week?…

NP’s can bill independently of the physician, but their reimbursement rate is only 85% of what a physician would be paid. Currently in Pennsylvania, advance practice nurses (APNS) need to have an overseeing physician to practice. They do no need to have direct supervision, but they need to sign a contract stating…

Social disparities exist in every socio-economics status, the one that is most prevalent at this time in our nation is the lack of healthcare, which, is something that affects countless individuals. The Affordable Care Act, which, is also known as ACA or more commonly known as Obama Care was supposed to be the answer for individuals healthcare needs. Needless to say, there are still several issues, the most prominent issue exists with the negative shadow that is cast upon the Medicaid program.…

According to ACFE’s article on False Employee Claims, “Occupational fraud is fraud committed by an employee on an employer during their employment” (False Employee Claims – Payroll Fraud, n.d.) “Common expenses claimed are private meal costs classified as business meals with clients, private travel expenses, and other entertainment expenses classified as business expenses” (False Employee Claims – Payroll Fraud, n.d.). In this case, the employee who is a “rising star” claims non-business…

and review of travel claims because it will prevent fraud. This paper will cover the background, implementation of training, and impact of filing a false travel claim. Background Service members are required to complete a travel claim for reimbursement upon completion of official travel. Additionally, the service member must be honest about claiming the expenses incurred on the DD 1351-2 travel voucher. The DoD Financial Management Regulation Volume 9 gives clear cut guidance on how to…

RCM unifies the clinical and business side of healthcare using both primary and secondary patient data, insurance, and provider and the revenue cycle is vital in creating compliant and efficient reimbursement processes. The revenue cycle is divided into four which are preclaims activities, claims processing, account receivable and claims reconciliation and collection. The preclaims submission is the first process in the cycle which begins with patient case management and preregistration such as…

When a patient is discharged from the hospital, under normal circumstances he or she will return to their respective home. But what happens when is one’s recovery becomes slower than expected? What options are available? Fortunately, skilled nursing facilities (SNF) exist to address this very issue. SNF are one of many different settings for long term care in which nursing and other therapy are provided to treat, manage, and evaluate care of patients who are slowly recovering after discharge…

There are three key components of a financial statement that any business manager should be aware of. The first, and one of the most important, is the income statement. It measures a hospitals profitability by tracking revenues, expenses and profit margins. The second, the balance sheet, “is a representation of the accounting equation of liabilities plus equity equal assets.” (Langabeer II, J. R., 2016, p. 60). It is a document prepared at regular intervals and gives stakeholders an idea…