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Discuss the financial impact of initially declined claims and delayed payments to healthcare organizations
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- Explain how the ACA could impact an organization’s strategic decision making and financial performance regarding healthcare reimbursement.When time is used as a key component in billing an E/M service, the provider must document face-to-face time with the patient and how much time was spent counseling the patient with the family.Coordination of benefits (COB) includes: Reimbursement when a patient is covered by more than 1 health plan Reimbursement for non-covered services Reimbursement for not medically necessary services Reimbursement for diagnosis mismatch
- What is the impact of the Anti-Kickback Statute on healthcare reimbursement and referralsDescribe what a compliance program is and explain the value of a compliance program for a healthcare facility and what the need for the compliance officer’s full authority?The Physician Self-Referral Law, also known as the “Stark Law,” generally prohibits a physician from making referrals to an entity for certain healthcare services, if the physician has a financial relationship with the entity. How can a physician get around the Physician Self-Referral Law?
- Discuss the role of prospective payment systems for outpatient, home health, physician and non-physician practitioners, and ambulatory surgical settings.Describe the various sources of funding beyond third-party reimbursement from which the various types of healthcare facilities can benefitDo you think NANDA-I, NOC & NIC are applicable to Nursing Documentation (conventional written or electronic) here in the Philippine Setting? Why or why not? If it needs improvements or changes to be more effective and applicable to Nursing Documentation, what would it be?
- List and discuss the risks to a healthcare organization in failing to allocate sufficient support and resources to a newly implemented healthcare information system or EMR.Explain how the provider’s perspective revenue cycle differs from the patient's perspective revenue cycle in ensuring revenue integrity.