QuickHelper

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About QuickHelper

Levels Tought:
Elementary,High School,College,University,PHD

Expertise:
Accounting,Applied Sciences See all
Accounting,Applied Sciences,Business & Finance,Chemistry,Engineering,Health & Medical Hide all
Teaching Since: May 2017
Last Sign in: 363 Weeks Ago, 1 Day Ago
Questions Answered: 20103
Tutorials Posted: 20155

Education

  • MBA, PHD
    Phoniex
    Jul-2007 - Jun-2012

Experience

  • Corportae Manager
    ChevronTexaco Corporation
    Feb-2009 - Nov-2016

Category > Management Posted 05 Oct 2017 My Price 8.00

Imagine that you are a Hospital HIM Manager.

Imagine that you are a Hospital HIM Manager. You have been asked to prepare an educational resource for some new employees at your hospital, including folks who will work in billing and coding as well as some physician practice managers. The billing manager is concerned about fraud & abuse and wants you to partner with him to develop guidelines and a training document that will be delivered live to the HIM, Billing, Finance and the Business Office employees. The billing manager is especially concerned about any fraud and abuse laws that should be followed. In relation to fraud and abuse there may be an audit process as well. The HIM department plays a vital role in the Recovery Audit Contractors (RAC) process. The HIM department must take charge of the audit process to ensure that RAC requests are received and processed on time. 

Part I.

Create a one page pamphlet (back and front) or booklet that can be given to current employees and included in a training handbook in the future. The pamphlet should include:

* Introduction to the topic

* An explanation of the concepts of fraud and abuse and how it relates to coding, chargemaster, claims management, and bill reconciliation processes.

* An overview of the major laws relating to fraud & abuse in healthcare, and the possible penalties for violations

* Incorporate at least two examples of enforcement actions that show serious penalties for billing fraud; you can use either this unit's Supporting Lesson Links or other examples that you find in your own research.

* Choose at least one of the “High-Risk Areas” from the OIG or RAC that you feel is relevant and propose two ways to keep your hospital from violating these laws. Be sure to relate and include in your discussion coding, chargemaster, claims management, and bill reconciliation processes.

Part II.

 review the table and determine the RAC for your state. Go to the RAC web address and review the procedure for requesting medical records.  Using Flowchart symbols found in Microsoft Word (or any flowchart software) create a graphic that outlines the RAC medical record request process.

http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Recovery-Audit-Program/Downloads/RACSlides.pdf

 

RAC

Web Address

Email 

Region   A: Performant Recovery 

States: CT, DE, DC, ME, MD, MA, NH,   NJ, NY, PA, RI and VT.

www.dcsrac.com

 <..o@dcsrac.com

Answers

QuickHelper
(10)
Status NEW Posted 05 Oct 2017 12:10 PM My Price 8.00

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