20 Mar Planned Proposal: Cost Structure, Reimbursement, and Financial Analysis in Healthcare
Scenario: Describe international standard diagnosis classificationuse in the US health care reimbursement and billing system.
Imagineyou were appointed the Chief Financial Officer of your hospital, and you have anew crisis to confront. Your hospital received an unannounced visit from a CMS(Centers for Medicare and Medicaid Services) surveyor following a seriouspatient billing complaint. Your hospital is well-known both regionally andnationally for quality and safety, but the complaint threatens the hospitalsCMS enrollment, accreditation, and reputation. The surveyor determined thatviolations did occur, and the hospital has 90 days to resolve the issue or loseits Medicare funding. The violations include upcoding, duplicated and phantomcharges, unbundling, and incorrect quantities.
You willcreate a planned proposal to deal with theviolations and return the hospital into compliance within the 60 days given byCMS.
Rubric:
1. Diagnosisclassification, care reimbursement, and the billing system
a. Explain theoverall concept of systems used in the hospital. Include three examples.
i. Diagnosisclassification
ii. Carereimbursement
iii. Billing system
b. Include athorough review of insurance company reimbursement procedures.
2. Meeting patientneeds
a. Explain how thehospital will meet patient needs, priorities, and expectations. Include threeexamples.
b. Include athorough explanation of the values of respect, compassion, justice, andcommunity pride in the care of the patient.
3. Violations
a. Address each ofthe violations. Include three examples of each.
i. Upcoding
ii. Duplicated charges
iii. Phantom charges
iv. Unbundling
b. Include athorough explanation of what will be done so these violations will not occuragain.
4. Contingency Plan
a. Develop acontingency plan for the future. Include three examples.
b. Include athorough explanation of how the hospital will be prepared in the future forsimilar emergency events.
Requirements:
2.5 pages; APA Format (7th edition)
Times New Roman; Font size 12; Double space
Title page; Reference page
Reference all sources; Quotingshould be less than 10% of the entire paper
Please use sources below, as applicable:
Gapenski,L. C. Healthcare Finance: An Introduction to Accounting andFinancial Management. (6th ed.). Health Administration Press. Chapter2
Gapenski,L. C. Healthcare Finance: An Introduction to Accounting andFinancial Management. (6th ed.). Health Administration Press. Chapter4
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