Identify and explain in detail the False Claims Act and it’s impact on Medicare and Medicaid programs.

Career Connect Essay

Explain compliance with regulatory requirements and reimbursement methodologies.

Directions

You are a lead coder at Bryant City Hospital and have been asked by your manager to prepare an essay to be included in the training manuals for incoming employees to the HIM department. This essay must educate new employees about The Centers for Medicare and Medicaid Services (CMS) regulatory requirements and the different types of reimbursement methologies used in various settings of care.

Your essay should be at least 500 words, thoroughly address each prompt, be free of grammar and spelling errors, use complete sentences and be organized in manner that makes sence to new employees. Rescources from your course material (already in APA format) should be used as supporting evidence. All resources used should be listed on the reference page.

Your manager would like you to identify the following items in your essay:

Identify and explain in detail the False Claims Act and it’s impact on Medicare and Medicaid programs.

Define fraud and abuse. Describe why it is important to follow CMS regulatory requirements to avoid fraud or abuse in billing and coding practices? Justify your answer.

Explain the Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS) reimbursement methodologies and determine when they are used. Explain the four reimbursement methodologies used in each of the settings of care below:

Inpatient Acute Care Hospital
Skilled Nursing Faciltiy
Outpatient Facility
Physician Office

Is there anything about the health condition/situation that the model does not adequately address?

Public service announcement critique

With the PSA selected https://www.youtube.com/watch?v=n7Wjf7Vtmp0
using the Precaution Adoption Process Model (PAPM) write a critique that incorporates the following:
An outline of the assigned model (15%)
Discuss the basic concepts/assumptions of the model and their interrelationship.

A description of the PSA’s message: (30%)
The undesirable health condition that the message wishes to improve or the desirable health condition that the message wishes to maintain The assumed context (target audiences, where, when, historical circumstances, etc.) The behaviour change that is promoted.

A critique of the message and the model: (40%)

How clear is the message?

Are the image(s) and language used, spacing of graphics, placement of object used appropriate? Why or why not? What assumption, specifically related to the assigned model, is the message making, and how plausible?

How can knowledge of the assigned model be used to improve on the message?

What other behaviour change assumptions (unrelated to the assigned model) is the message making?

Is there anything about the health condition/situation that the model does not adequately address?

Organization and writing: (15%)

Grading Rubric

o Outline of model 15%
o Description of PSA message 30%
o Critique of message and model 40%
o Organization and writing 15%

Evaluate the opt-in and opt-out selections for patients as they relate to HIEs and justify your opinion on which selection has the better chance for success and why.

313 Health information exchange models

Competency 111.7 III,

1. Evaluate the three different models of health information exchanges (HIEs): centralized, federated, and hybrid, and include how privacy and security practices will factor into which model is implemented.

2. Evaluate the opt-in and opt-out selections for patients as they relate to HIEs and justify your opinion on which selection has the better chance for success and why.

Resources AHIMA Thought Leadership Series. 2012. Ensuring Data Integrity in Health Information Exchange. http://library.ahima.org/xpedio/groups/publicidocuments/ahima/bokl_049675.pdf. AHIMA. 2013. Understanding the HIE landscape. Journal of AHIMA 84(1):56-63.

Explain the requirements of Meaningful Use and its role in the Merit-based Incentive Payment System.

Health Information Exchange

Learning Objectives

Illustrate why the health information exchange (HIE) is a positive step for healthcare

Describe the role and function of the health information organization (HIO) in the HIE efforts

Explain the concept of interoperability and its importance in healthcare

Compare and contrast the benefits and barriers of HIE

Compare and contrast the models and methods of HIE

Explain the requirements of Meaningful Use and its role in the Merit–based Incentive Payment System

Discuss what else we could encourage service user to do ( for exercise/movement) and we decided that we would all encourage her to wash the cats food bowls.

Support individuals to retain,regain and develop skills to manage their daily living

Reflective account using Graham Gibb model, focusing on Mobility.

Am a support worker,supporting someone to live independently in their own home.

Service user has cerebal palsy causing limited Mobility,one of the things the service user does to retain mobility, is to be as active as possible around the house, service user would let her cat in and out, then decided to get a cat flap installed thus reducing her movement. Support workers had team meeting to discuss what else we could encourage service user to do ( for exercise/movement) and we decided that we would all encourage her to wash the cats food bowls.

Which of these strategies would help prevent a similar event from occurring at the hospital described in Critical Concept 8.2?

Discussion Board Topic:

Read the description of the wrong-site surgery event in Critical Concept 8.2 and the root causes identified by the team who conducted the RCA. Conduct an Internet search for risk reduction strategies aimed at preventing wrong-site surgeries.

Which of these strategies would help prevent a similar event from occurring at the hospital described in Critical Concept 8.2?

Must be 250 words in APA format with two cited sources

Textbook information

Spath, P. (2018). Introduction to healthcare quality management, 3rd edition. Health
Administration Press. ISBN: 9781567939859

Discuss options to improve the financial and operational performance of nonprofit organizations and the criticisms leveled at for-profit healthcare organizations.

Week 3

Use Google search, the DeVry-Keller Online Library, and/or one of the approved websites posted in the Web Resources section of the Course Resources page to find a research article(s) related to nonprofit versus for-profit healthcare and organizations. Analyze the characteristics of each type of organization and the factors that impact operations.

Discuss options to improve the financial and operational performance of nonprofit organizations and the criticisms leveled at for-profit healthcare organizations.

Your resultant written paper should be 3-4 pages, double-spaced, and in APA format. Your primary text and the journal and website research article must be used as references to support your analysis and summary paper. Use at least three references.

Review the grading rubric for all written weekly assignments in the Syllabus, and post your finished paper as a Word document.

Is a janitor’s or schoolteacher’s life worth less than a Fortune 500 CEO’s because the CEO earns more money and owns multiple houses and cars and has stocks and so forth?

Watch Worth on Netflix and compose a three-page paper that examines the societal inequities, health care disparities, and medical ethics portrayed in this series.

“Can you put a price tag on a life?

“Worth” delves into that question by telling the story of the 9/11 Victims’ Compensation Fund. The fund was created by an act of Congress to ease the suffering of families who lost loved ones in the attack and (perhaps more importantly, from the government’s standpoint) keep them from suing the two airlines whose planes were hijacked.

Is a janitor’s or schoolteacher’s life worth less than a Fortune 500 CEO’s because the CEO earns more money and owns multiple houses and cars and has stocks and so forth?

That’s the sort of question that the people in charge of the fund had to answer every day between the establishment of the fund and its two-year deadline for payout.”

Examine the AHIMA professional competencies to maintain relevancy as an HIM professional.

Objectives

Examine the AHIMA professional competencies to maintain relevancy as an HIM professional

Develop a five-year career development plan

Instructions

Review the Chapter 11 Case Study and AHIMA competencies and develop a career plan based on individual career needs. A career plan template is provided below.

Deliverables

Create a five-year career plan for Mary Beth using the template provided. Include three strategic goals that Mary Beth should work on within her current facility to demonstrate relevancy in the HIM profession and for each of these strategic goals identify three operational goals similar to those in table 11.4.

Identify two internal forces impacting HIM (table 11.2) and provide two resources from the AHIMA

Body of Knowledge that Mary Beth can consult to gain additional knowledge.

Identify two external forces impacting HIM (table 11.2) and provide two resources from the AHIMA Body of Knowledge that Mary Beth can consult to gain additional knowledge.

Create two personal goals for Mary Beth in regards to long-term career development.

Textbook Information

Kelly, J.r. & Greenstone, P.S., (2020). Management for the Health Information
Professional, 2nd edition. AHIMA Press