Reimbursement

issue of quality of care, a major influencer in Medicare reimbursements. Bob Pritts, the department administrator, argued that Patients who are smokers, diabetic, and have a BMI of 40 - 45 greatly impact the quality of care for their orthopedic surgery patients, which could increase LOS and decrease reimbursements. On one hand, if the department follows most institutions and limits services to patients with these factors, their reimbursements will be better. On the other hand, accepting patients…

system, coded data has taken on a greater significance and became a mechanism for reimbursement, quality measure reporting, and profiling has become even more of a strategic imperative than perhaps ever before. Documentation is essential for patient care, not because only it validates the care given, but can enable the sharing of key data between care providers, which optimizes the healthcare claim and reimbursement. The clinical documentation improvement (CDI) focuses on improving the quality…

release. While innocuous billing does not prevent payment, it delays reimbursement to enable a thorough review and transaction data funnels back into the predictive modeling system, refining…

Planned Parenthood is a healthcare provider assisting men, women, and teenagers with both treatment and information. Planned Parenthood is a service providing affordable healthcare through health centers run by their respective self-governed affiliates. However, following the surfacing of some controversial videos in early July, the necessity of the funding which Planned Parenthood receives from the US government was brought into question. Hence, Congress began a hearing to remove the federal…

the author points to the change from “fee-for-service model” to the ACO model (Hart, 2012, p.25). The provider has “incentives” to provide quality care and outcomes; hence, the “ACO can be rewarded for providing better care” and receive better reimbursement for the health network and/or facility (Hart, 2012, p.25). This helps to decrease the cost of health care by decreasing unnecessary test and treatments. According to the “ANA president” the “ACOs must be more than just a business structure…

threats that must be understood and managed as it continues to expand in its current market. These threats include growth of competitors, larger marketing budgets of competitors, governmental regulations, local hospital expansion, and insurance reimbursement changes. The rapid growth of rival dermatology and cosmetic surgery practices is a significant threat to The Woodruff Institute, as it attempts to manage organizational changes. While the practice has four locations in Lee and Collier…

capitated model will have incentives to modify contracting and coordinating efforts with the facilities to reduce patient admission from the facilities” (Brandal and Cook, 2013). Medicare and Medicaid managed care program with a capitation model of reimbursement delay an enrollee’s nursing home admission by increasing use of home and community waiver services, discouraging unnecessary inpatient hospital admissions (Brandal and Cook,…

CHS was unable to effectively manage billing and reimbursement across the organization which resulted in an increase in billing costs, fall in collection rates, and accounts receivable rose to a point where the value of the acquisition was diminished in some cases. In addition, poor claim management also had a negative effect on billing and reimbursement. The findings from the audit allowed CHS to take a step back and look at the key components that impacted the organization negatively. CHS…

Good morning Widgets R Us Employees, I am pleased to inform you that Widgets R Us is offering a tuition reimbursement program for the hard-working employees that run this company. We value professional development, as well as always motivating our employees to better themselves in and out of the workplace. This is a great opportunity for our employees who want to go back to school, but as with any program, there are a few criteria employees must meet to qualify for the program. To start off, the…

Misappropriation and Embezzlement schemes There are various reasons for fraud existing: Non-For-Profit Organizations often have few internal controls, and income is typically not connected with a good or service. When a person who is entrusted with assets misappropriates them for personal use, the embezzlement will produce. It ordinarily involves an employee or agent entrusted with assets of an organization. The misappropriation and embezzlement schemes including as following: (1) Skimming…