Discussion: Inpatient Hospital Reimbursement

Discussion: Inpatient Hospital Reimbursement

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Discussion week 4
Please review the discussion board rubric under “Start Here”.

Use in-text citations appropriately and provide full citations for your initial post and at least one of your response posts. One of your citations needs to be outside of your text.

The idea is that you would not only comment on your classmate’s post but also do some additional research furthering the discussion.

To begin discussing in this forum, click the forum title, “Week 4 Discussion Forum”. Then, click Create Thread on the Action Bar to post your initial reply. To reply to a fellow participant, click the title of the initial post, then click Reply.

Kristin Cook

Week 4 Payment Methodologies

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Total views: 2 (Your views: 1)
1) Fee For Service is where the payer has a fee schedule with a set reimbursement amount for each service covered. Cost Based is for facilities that receive payments throughout the year until the cost report comes out. Then the payments that have been received are deducted from the remaining amount. Prospective Payment inpatient hospital reimbursement was based on the DRG data that already appeared on the claim. Ambulatory Surgical Centers are based on only procedures that are performed. Skilled Nursing Facilities payment based on the acuity or illness of the patient has been used.

2) Medical necessity is where you have a procedure done for a diagnosis and when it is sent to claims it can either be approved or denied. If it is denied that means that the insurance company doesn’t believe the procedure or tests run for that diagnosis was necessary. This impacts payment a great deal because if a patient has insurance, but the insurance company will not pay for the procedure or test that were done that means that the patient has to pay out of pocket. This can be very difficult for patients that live on a fixed income.

3) Payment methods now have changed coding for the better. Everything that we do now as a society is done electronically now, this means that every claim that is filed it is done electronically. Everything can be filed and stored electronically and still meet HIPAA’s requirements for patient privacy and safety.

Reference

Aalseth, P. (2015). Medical Coding: What It Is and How It Works. Second Edition. Boston, MA. Jones & Bartlett Learning.

Chenelle Weaver

Week 4 Discussion (Initial post)

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Total views: 9 (Your views: 1)
Refer to Chapter 4, focus on pages 179 – 188 and discuss payment systems. Demonstrate understanding of fee for service, cost based, and prospective payment systems. Fee for service is a designated reimbursement amount for service rendered. Cost based details the cost of running a business and receiving payments. A Prospective Payment System (PPS) is a method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount. The payment amount for a particular service is derived based on the classification system of that service. CMS uses separate PPSs for reimbursement to acute inpatient hospitals, home health agencies, hospice, hospital outpatient, inpatient psychiatric facilities, inpatient rehabilitation facilities, long-term care hospitals, and skilled nursing facilities. Explain medical necessity and how it impacts payment. Medical necessity refers to a decision by your health plan that your treatment, test, or procedure is necessary for your health or to treat a diagnosed medical problem. Most health plans will not pay for healthcare services that are not considered medically necessary. A common example of a non-medically necessary procedure is a Botox. If the procedure is considered to not be necessary the claim may be denied thus affecting payment. What is the effect of payment methods on coding? Use of the correct codes ensures the correct payment method will be used.
Reference:

www.medicalbillingandcodingonline.com/medical-coding-for-billers retrieved on June 29, 2017

Discussion: Inpatient Hospital Reimbursement

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.
Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.
LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication

Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.