Healthcare Reimbursement
Research and analyze payment methodologies and put into a chart. Then two scenarios with power points using APA reference stye
Healthcare Reimbursement
Payment Methodologies
This assignment has two steps: Step 1 with a preview & final review must be completed prior to performing Step 2. Step 2 has two scenarios. Use a minimum of 5 resources on this assignment.
STEP 1: Research and analyze the following payment methodologies:
Capitation
RBRVS
Prospective Payment Systems (Identify at least 5 types)
Create a visual tool (like a chart matrix grid) using a software program to help you understand and identify the following:
Define every payment methodology
History of each
Which payers use it which methods
What governing body or organization may be involved in managing it
Which type(s) of healthcare setting it is utilized
(Visual tools may be: Tables Charts Diagrams Mind Maps etc.) The visual tool is to be clearly defined readable professional appearing and fit on 1-2 pages. **This will be an excellent reference to assist you in studying for the CCA or RHIT Exam or preparing for a job interview!
Submit Step 1 to instructor for review prior to working on Step 2. (End of Module 3)
Step 1 is worth 25 points based on feedback from the instructor corrections are to be made and resubmitted for final review prior to Step 2.
Final Review is due at the end of Module 4.
NEXT IS STEP 2
STEP 2: Perform presentations on scenarios A & B.
Scenario A: Physician Group
The independent physician group you work for are starting to renegotiate their insurance contracts with various commercial plans and want to understand the various payment methodologies: Capitation RBRVS and a prospective payment system that would benefit an independent physician group.
Create a PowerPoint presentation for the physicians that includes the following:
o Definition of each payment method
o Compare and contrast the pros and cons of each
o Provide examples of how they may be paid for the following items:
? Office Visits/Procedures (Provide 2-3 E&M CPT codes)
? Lab tests (Provide 2-3 CPT codes)
? Injections ie: vaccine or injectable medications (Provide 2-3 CPT / HCPCS codes)
In the PowerPoint you must include:
o what your clinic charge is for the examples provided above
o what the reimbursement may be based on the payment methodology chosen
o Proposal of what methodology they should use for reimbursement of the above examples and why
Scenario B: Nursing Home
The nursing home you are recently hired at has a new nursing home administrator. The administrator would you like you to explain the components of the Resident Instruction Tool (RAI); and how it affects the RUG reimbursement the facility receives.
In a separate PowerPoint geared toward the NH Administrator and staff explain what encompasses a RUG and how often it is reported to CMS. Formulate a step-by-step plan for the staff to report the RUGs on the required dates of the patient stay.
Resources: Research should be based on reputable sources not Wikipedia. Resources include government agencies Wisconsin Part B insurance provider commercial payers professional agencies such as AMA AHIMA etc. You may also use the FVTC HIT program library links provided online.
The PowerPoints should have sources noted in APA Reference Style on the final page.
Step 2 (two Powerpoints) is worth 25 points. Step 2 is due at the end of Module 6.