Miscoding on the Billing Forms Discussion Board
The fundamental basis for auditing Medicare and Medicaid billing is that the services provided are confidential, patient privacy must be protected, and the written word of the provider is the record of service provision upon which a review must be initiated (Harris, 2007). Auditing, however, must extend beyond the written record to establish that the services were actually provided to the patient or client and that the services were rendered according to the conditions described in the provider's written record (Harris, 2007)
As the practice manager, I would remind the physician that every employee has a duty to cooperate and a duty of loyalty to the employer. And I would explain that these duties obligate employees to comply with reasonable directions from their employers during an internal investigation. The employee should be party to a conversation that an internal investigation may or may not commence based on the information provided, however, not providing information and cooperating with my word as a practice manager will not alter the course of the next steps that will be taken.
Since every healthcare organization, including -- presumably -- DOCS RU.S. -- has a Compliance Program...
The physician will be reminded of the conflict of interest (COI) document that she ostensibly signed, and there is an expectation that she has conducted her practice according to that COI and in compliance with the required billing stipulations for Medicare and Medicaid (Murphy & Vandenberg, 2003.
Assuming an investigation will be conducted, the main priority at the beginning is to review the match between the numbers of tests or procedures, the costs permitted, and the resultant revenues generated by the provision of care (Harris, 2007). During the investigation, I would review the policies and procedures of the DOC RU.S. with the employee, and also to ensure that any perceived violations are established in policy and procedures guidelines (Murphy & Vandenberg, 2003. The perception is that the offense has been on-going, and I would need to document this in a clear audit trail (Murphy & Vandenberg, 2003. All of the pertinent information will need to be written and summarized in a report that will be given to the appropriate authorities (Murphy & Vandenberg, 2003. The investigation will…
Originally, this included 120 days of hospital benefits and 120 days of nursing-home benefits. General revenue funds from the program would also be applied towards hospital construction equipment purchase and grants to teaching hospitals. The second part of the law, also known as Part B, concerned physician visits. Initially, Part B was known as Eldercare, the American Medial Association's (AMA) alternative to Medicare. Mills however reformed it to become an
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healthcare issues country. How solve ongoing problem Medicare Fraud Abuse government sufficient effective regulation enforce. If, resolve problem? recommendation ? It Economics Healthcare economically sound. Economics of healthcare The population of the modern day society is faced with incremental pressures, but also incremental challenges, and these new issues impact all aspects of life, including the provision of healthcare services. For instance, the more and more technological developments made within the medical
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Healthcare Fraud Identity theft and fraud of many types and forms are obviously a major inconvenience and hindrance to anyone that falls prey to a person that engages that crime. There are many variants and forms of fraud and identity theft out there. One of the more insidious and nasty examples of those crimes would be that which relates to healthcare. Indeed, to have people's wallet, healthcare and the taxpayer dollar