Billing Costs and Rates - Assignment Example

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Billing Costs and Rates Table on Content Step One……………………………………………………………………………………………………………...3 Question 6………………………………………………………………………………………………......3 Reviewing billing practices and physician relationships……………………………………………….3 Actions recommended and corporate compliance plan……………………………………………….3 Question 7………………………………………………………………………………………………….3 Medicare Initiatives on physician payments……………………………………………………………3 Health-association infection and readmission payment………………………………………………3 Step two………………………………………………………………………………………………………………4 Key elements of Green Valley Medical Center’s strategy……………………………………………..4 Capital budgeting system needs a change…………………………………………………………......4 Two projects………………………………………………………………………………………………..4 Acceptable project………………………………………………………………………….......................6 Step three…………………………………………………………………………………………………………….6 Critiques of the methodology and findings of the benefit/cost analysis……………………………...6 Level of Funding…………………………………………………………………………………...............6 Conclusion ……………………………………………………………………………………………………….......7 References…………………………………………………………………………………………………………...8 Step one Question 6 Reviewing billing practices and physician relationships The US attorneys are evaluating whether the standard billing practices are adhered to within the hospital. The billing procedure involve: Enter patient details into an EHR software program; Entering ICD-9 and CPT codes from the main bill into the patient’s documentation; Automatically Transmit claims to cover providers; receive an audit statement, review and correct errors, resubmit discarded claims then post payment to patient account (Ferenc, 2013). Physicians must maintain correct and complete therapeutic records and documentation of the services they offer. They should ensure that the claims they present for payment are backed up with proper documentation. Physician relationship with patient, billing department and management would be reviewed. I think Bobcat Community Hospital is liable for poor billing practices and poor physician relationships. Actions recommended and corporate compliance plan The hospital has retained some physicians for more that 10 years thus compromising on services. The action that has been taken is to control the period a physician can stay within an institution. Yes, corporate compliance plan is needed. Corporate compliance plan would detect and prevent violation of regulation by the physicians, agents, officers and director of the hospital. Physicians are under the same law no matter the location thus no breaks for rural hospital in dealing with physicians. Question 7 Medicare Initiatives on physician payments The two percent across-the-board cut to Medicare physician remuneration mandated by the centralized budget sequester has been an issue for a while; however implementation was to commence as from April. Physician would compromise service delivery in reaction to payments cut. Health-association infection and readmission payment Since 2009, it is true that Medicare stopped payment of medical expenses incurred due to hospital negligence. That means Medicare will not be paying for operations to remove items accidentally left inside a patient during surgery, and neither will it reimburse for treating patients who obtain the wrong blood category in a transfusion. But the key impact will be in the region of hospital obtained infections. Step two Key elements of Green Valley Medical Center’s strategy The GVMC’s strategy concentrated on efficient services, financial and cost saving activities contribution to the hospital. This made the management concentrate on services and financial gain without much attentions on physicians well being. Capital budgeting system needs a change Current capital budgeting seems need a change due to the prospects of creating a structure that finally had a rational, methodical approach to assessing capital requests. By involving the subjective analysis that is possible to quantify some of the hospital's benefits necessitated change implementation. Two projects The two projects will fare well under Mr. Klein's new capital budgeting technique since it has complete awareness of the requirement. Application of net present value facilitate appropriate discount allocation also division of equity capital between permanent restricted funds and unrestricted funds provided a good environment for the projects to succeed. The PET Proposal and the laundry proposal fit well within the revised capital budgets of Mr. Klein. Net present value is the current worth of net cash inflows produced by a project including recover value, if any, less the first venture on the project. The PET proposal’s net present value (NPV) NPV = R ? 1 ? (1 + I )-n ? Initial Investment i In the above method, R is the net cash inflow predictable to be obtained each period; i is the needed rate of return per term; n are the number of terms during which the plan is expected to work and produce cash inflows (Needles, Powers, and Crosson, 2011). R = $ 1,700 (1.7M) I = 10% N = 10 years Initial investment $ 1.4M NPV = 1.7*6.1-2.8 =6.2 M The laundry proposal’s net present value (NPV) R =$197,000 I = 10% N = 10 years Initiate investment $393,120 NPV = $ 808,580 In both cases the IRR was 10% Acceptable project The project that would be acceptable is Laundry proposal since it has a return that is considerable and also facilitate saving due to cost reduction. PET proposal require much income and also facilitate high cost of maintenance. Cheaper and reliable equipment could be instituted to alternatively. Step Three Critiques of the methodology and findings of the benefit/cost analysis The methodology only concentrated on the fatality rate yet accidents do cause some injuries that leave victims maimed and unproductive. The method of benefit /cost analysis must also cater for the unproductiveness caused by maiming of accident benefits. The criteria of providing feasible and realistic methodology must be made explicit to allow other road safety stakeholders to make contribution and critics as well. This would ensure criteria get enough legal support and analysis is carried out accurately. The cost of enforcing safety laws, reconstructing road designs and improving road engineering may not yield equal benefits in preventing road accidents if road users’ attitudes are not transformed. Training and educating the users would compound these costs with more benefits since as indicated in exhibit two some accidents are due to ignorance. The accidents are not caused by motorists alone, other road users such as pedestrians or cyclists also cause the accidents. The methods are good, however, would be better if broader road accidents’ causes determined and analyzed. There is no use of common denominator in analyzing road accidents since various regions are faced with diverse causes of vehicular accidents. Findings are quite general thus does not give proper analysis of the situation. Level of Funding On evaluation, educational awareness of proper road usage would reduce the costs further. On this basis I do not recommend the level of funding proposed. As stated earlier, no common denominator is applicable when road accidents are involving thus blanket assumption plus funding proposal is not applicable. The team must undertake feasible and realistic analysis explicitly to back up their funding proposal. Conclusion Mr. Klein proposals are viable and would save the hospital from overspending. It is also clear that physicians’ service would be boosted due to proper investment of return from the services they render. The billing system of project in step one has to be changed and also recommendation to include corporate compliance plan must be implemented. Realistic and feasible road accidents analysis must be explicit. References Ferenc, D. P. (2014). Understanding hospital billing and coding. St. Louis, Mo: Elsevier. Needles, B. E., Powers, M., & Crosson, S. V. (2011). Principles of accounting. Mason, Ohio: Cengage Learning. Read More