Sign Up Now
Get instant access to over 1 million+ study documents
OR
Already registered? click here to login
By creating your account, you agree to our terms of service, privacy policy and student honor code.
PO Discounts
PPO, Preferred Provider Organization, is mainly an "under-raps" or silent activity that mainly highlights how a solitary unit can and does take un-permissible discounts at the payment of the medicinal claims of clients or patients. This particular activity is silent because the service provider has not idea that a discount will be taken or whether it is right to do so.
The complexities lying in the understanding of a PPO can be made easier by understanding the parties involved who demand or ask for the discounts by the medical centers. These parties can be directly or indirectly linked to the business and encompass institutions like insurance corporations, self-insured owners, health preservation groups, union trusts, (and more recently, with the concept of a returning fee) supervised care associations and third-party managers have also joined the party. Another new concept, "broker" of discounted rates further complicates matters as an entity solely responsible for such activity emerges onto the scene. Of course, one way of avoiding PPO discounts is when the hospitals completely identifies the parties involved and hinders their activities legally; another barrier here though is if the federal or state law is handling the project.
The introduction of RUG-53 on Jan 1, 2006, indicated the addition of further new categories in the Medicare reimbursement Prospective Payment System since its initiation 8 years ago. Nine new paying groups, making a total of 23, were added within the rehabilitation category. The main aim was to be able to provide more finances for the complicated medicinal expenses while still maintaining a regular and neutral budgeting format. Keeping this in mind, the Case-Mix Indices were rearranged, and the refund was restructured amongst the top 35 paying units, making the new additional 9 units pay more and have the highest Mix Indices Values than the other 26 and the last 18 paying units facing a small percentage increase in their contribution.
Bibliography
http://www.hfma.org/hfm/2006archives/month11/silentppo.htm
Speisman, A. (2006) "Challenging Silent PPO Discounts," QAMCO, Member of the Nevada Chapter.
Hachenburg, M. "Challenging Silent PPO Discounts," QAMCO.
Business Case Quality for Athens Medical Center A cost reduction, and high quality healthcare delivery are paramount to the values of a healthcare organization. Typically, a cost reduction is driven by operational quality, and clinical improvement leading to removal of harm, variation and waste. The objective of this paper is to present a business case to achieve quality improvement for Athens Medical Center to deliver optimal quality improve patients outcomes. Moreover,
VA Medical Center Quality Improvement at the Philadelphia VA Medical Center The Philadelphia Veterans Affairs (VA) Medical Center is in the process of improving their quality of care for patients. The VA Medical Center provides care to veterans of the United States military and their families. The Philadelphia VA Medical Center has a list for quality improvements; of which one of the main objectives for improvement is customer service. In this paper
Montefiore Medical Center (MMC): A Case Study This study reviews a Harvard Business School case on Montefoire Care Centers. The Balanced Scorecard is chosen for the strategic management initiative at Montefoire and the reasons and results of such a choice is reviewed in this case study. The objective of this study is to answer the question of what were the underlying reasons for the development of a new strategy at Montefiore Medical
Montefiore Medical Center Reasons for Developing New Strategy Designing the new strategy involved several meetings by the Medical Center's employees to assist in the development of a balanced scorecard and initiating nation-level measures. In this regard, the firm developed a new strategy to represent the cause-and-effect linkages among the environment, strategy, and operating plan that could deliver the required financial results. The new system proposed by the strategy was initiated to ensure
Schneck Medical Center Provide a description of the company, its mission, and values SMC (Schneck Medical Center) is a nonprofit healthcare organization that provides specialized and primary care services. The center was established in 1911 with a donation of five thousand dollars and a land from Mary Schneck (Jcr, 2007). It was established in memory of the founder's Husband to provide healthcare requirements to people of Jackson County. Initially, the center had
Schneck Medical Center: The Baldrige Award Schneck Medical Center: Overview The Schneck Medical Center according to the National Institute of Standards and Technology -- NIST (2011) "is a 93-bed nonprofit hospital providing primary and specialized services to the residents of Jackson County, Ind., and surrounding communities." The facility as NIST (2011) further points out, offers a variety of primary care services including but not limited to cancer care, noninvasive cardiac care, and