HI215 Reimbursement Methodologies Unit 4 Assignment Instructions and Worksheet
(Use this document as a worksheet to complete this assignment)
Objective: To evaluate the course outcome HI215-1: Examine the reimbursement processes of different health insurance plans.
Point Value: 250 points.
...
HI215 Reimbursement Methodologies
Unit 4 Assignment Instructions and
Worksheet
(Use this document as a worksheet to complete this assignment)
Objective: To evaluate the course outcome HI215-1: Examine the reimbursement
processes of different health insurance plans.
Point Value: 250 points.
Assignment Activities include the following:
1. Review the Health Finance Case Study on “Primary Care Financial Management” (20
points)
Questions:
1. What would you recommend that ABC Primary do to tighten up the
financial of the practice? List at least three items along with your
rational.
• It is essential to record all monetary data with the goal that each dollar
can be represented. ABC did not keep up work force action reports which
imply that it was obscure whether compensation and periphery benefits
were admissible.
• ABC needs to isolate uses identified with Government stipends and
those identified with other financing sources. ABC needs to make it a
best need to be responsible for the money related administration
framework. Bank articulations were not made, kept up and
accommodated in an opportune way which made their budgetary data
inconsistent.
• ABC needs to refresh acquirement systems also keeping in mind the end
goal to ensure that they are getting products and ventures at sensible
costs.
2. Review the provided OIG website link for any additional information and background.
2. Review the Health Finance Case Study on “Claims Management”. (10 points each/20
points)
This study source was downloaded by 100000829878664 from CourseHero.com on 08-08-2023 09:40:48 GMT -05:00
, 1. What should WPS do with CMS to improve the process? Review the provided
OIG web link for additional background and information.
• The installment issues that happened were a direct result of charging issues
inside the clinics which imply that billers and coders should be more
tenacious and focus on detail when preparing claims. It might be useful
to
have a consistence officer that knows about directions and strategies and that
can perform arbitrary reviews to guarantee that coders and coding legitimately
which thusly enables the billers to charge the methodology appropriately.
WPS and CMS might need to make a check procedure also so the data is exact
inside the two domains.
2. As an executive for the Wisconsin Physicians Service (WPS) Insurance
Corporation, after reviewing the case, what recommendations would you
propose to the Board of Directors that they should prepare for as a
response from the OIG? List at least three
recommendations along with your rational.
• I would prescribe a meeting with specialists and medical attendants to go over
appropriate documentation of techniques and hardware utilized.
Likewise,
include charging staff to ensure legitimate charging codes are being utilized.
Additionally, to enlist a review organization to assess what and where the
separation is in the documentation.
• I would prescribe that appropriate documentation for increments in salary.
Rational: Legitimate documentation is fundamental for finance and without the
best possible printed material; evidence of what happened to the cash is
faulty.
I would likewise suggest legitimate documentation for bank articulations and
contract an expert bookkeeper to keep the announcements in order.
Rational: In any business little or vast, a lawful bookkeeper ought to be set
up
to catch up with reviews and to again demonstrate what happened to the cash.
This study source was downloaded by 100000829878664 from CourseHero.com on 08-08-2023 09:40:48 GMT -05:00
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller docguru. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $8.99. You're not tied to anything after your purchase.
