Consider the following scenario:
Derek Gonsalez is a 64-year-old man who has had several problems with his knees. Derek has sought many treatments in an effort to reduce the inflammation in his knees, and his doctors have determined that he is a good candidate for a full knee replacement. Derek starts out by attending a pre-operative visit with his orthopedic surgeon where he schedules his surgery and obtains instructions for his surgery. On his surgery day, Derek is admitted to the hospital. He stays there for several days after his knees are replaced. After being discharged, Derek is given pain medication and a referral for 6–8 weeks of physical therapy.Operations Management homework help
Depending on the type of insurance and the healthcare organizations involved in this scenario, the claim(s) could be reimbursed “prospectively” or “retrospectively.”
Reimbursement methodology involves quite a few terms, concepts, and computations. It can be challenging to keep all of the similar sounding variables straight. However, as a healthcare professional, you need to be aware of these terms and concepts and have a basic understanding of how reimbursement is determined.
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This week, you will choose a payment system, analyze how the system determines reimbursement, and determine the benefits and drawbacks of the system. In addition, you will analyze a case study and propose an action plan to eliminate errors in reimbursement.
Assignment: Home Health Case Study
In order for healthcare facilities to be properly reimbursed, certain requirements need to be met. For example, consider the scenario in this week’s Introduction. Before determining that Derek Gonsalez needed a total knee replacement, his doctor performed a physical examination, X-rays, and other tests to determine the cause and extent of the damage. All of these tests would have been properly documented with pertinent information sent to the insurance company for surgical pre-authorization. This is the case with many different conditions and procedures.
In this Assignment, you will examine a case study involving home healthcare and the requirements associated with it. You will propose a plan of action to ensure that patients who need face-to-face encounters receive them.
To prepare for this Assignment:
• Read the document, Case 8: Home Health,” located in this week’s Learning Resources.
• Consider how home health claims data were used to review the accuracy of reimbursement.Operations Management homework help
The Assignment (5- to 8-slide PowerPoint presentation):
Imagine that you are in charge of the billing for a home health organization. You have been tasked with creating an action plan to ensure that all patients who need a face-to-face encounter receive one. Your action plan needs to be communicated to the various stakeholders, so you are asked to present it at the next staff meeting.
Your action plan should have the following parts:
• Part 1: The Issue
◦ Give an overview of the case study and findings. (1–2 slides)
◦ Explain why the face-to-face encounters are important and how they can impact reimbursement for services. (1 slide)
◦ Provide talking points in the “Notes” section of the PowerPoint.
◦ Provide specific examples.
• Part 2: The Solution
◦ Present a step-by-step action plan that will ensure that all patients who need a face-to-face encounter receive one. (2–3 slides)
◦ Include at least one strategy for discussing the face-to-face requirement with providers/physicians. (1–2 slides)
◦ Provide talking points in the “Notes” section of the PowerPoint.
◦ Provide specific examples.
• Part 3: References
◦ Support your action plan and strategy or strategies with the Learning Resources and at least one outside scholarly source. Operations Management homework help
