Briefly, the summary judgment facts of St. John v. Pope (1995) noted that Pope, who had recently undergone back pain surgery and epidural injections at Round Rock Hospital, went to the Central Texas Medical Center emergency room in San Marcos for back pain and fever. The emergency room physician, at Central Texas Medical Center, telephoned St. John, the on-call physician, who recommended Pope be referred to the Round Rock Hospital, where his surgeon was on staff. However, when Round Rock Hospital’s emergency room refused to accept Pope, he went home. The following day in a hospital in Austin, a lumbar puncture revealed Pope was suffering from meningitis, which resulted in permanent disabilities (St. John v. Pope, 1995).…
Jessica McGowan HIM 2330 – Shaw July 2, 2014 Reimbursement Assignment and Case Mix Case #1 Female 66yo 01-Home ICD-9-CM Code Code Description Principal Diagnosis 682.7 Cellulitis, left foot Secondary Diagnosis 892.1 Infected dog bite 041.10 Staph infection E906.0 External cause: dog bite Principal Procedure 86.22 Wound debridement, foot Total Charges $6,245.10 DRG: 0572, SKIN DEBRIDEMENT W/O CC/MCC DRG Wt. 01.0077____ Full Update Hospital Reimbursement___$5,064.79__________ Reduced Update Hospital Reimbursement__$4,762.49…
Edgewood Lake Hospital (ELH) which opened in 1945, is a 30-bed, independent, not-for-profit hospital located in rural northern California. It provides inpatient and outpatient services to the close-knit community that resides within the forested and lakeside town the facility is nestled in. Although it is known for its great track record for quality and is held in high regard by the surrounding community, it has steadily experienced financial losses from 2006 through 2009. These losses can be attributed to factors both internal and external to the facility itself.…
Linking like patients with like-resource consumption allows hospitals to perform cost management by DRG or DRG groupings.…
Reimbursement Methodologies, HIT 115 02386600 POA indicators defined as Present on Admission variables, which are reported on an inpatient claim, indicate the primary & secondary diagnosis, that were present at the time the inpatient admission occurs. POA indicators are required for all claims involving Medicare Inpatient admissions to general IPPS acute care hospitals, or facilities that are subject to regulations mandating the collection of POA indicator information. POA indicators are used when submitting claims to denote the patients condition upon admission. POA indicators are also used to differentiate upon admission diagnosis, versus hospital acquired diagnosis’s.…
After review the cast study regarding Southern Baptist Hospital (SBH), one can conclude that the extent to which SBH researched the need of its audience prior to developing a marketing strategy was not very far. For example, the case gives us the understanding that the public already had a decent opinion about SBH. As a result, an advertising campaign that focused sorely revamping this position would not increase value or add to the company market share. With that said it is evident that SBH had not completed adequate research or thoroughly considered the audience needs prior to developing its market plan. Moreover, the case suggests that SBH had an overall marketing plan, however the plan in my opinion, was not substantial. It is evident that the campaign was developed as quick reaction and solution to an urgent need. However goals that pertained to planning a successful marketing strategy were not properly assessed. As a result, one can clearly see that SBH did not have a significant grasp on the nature of marketing. In my opinion, SBH were oblivious to the value that a successful marketing strategy could bring to the establishment. Nevertheless, the implication of focusing marketing efforts on corporate image rather than the services the organization provides a company with the necessary tools to develop a good brand and reinforce the positioning the brand occupies in hearts of their target customer base. On the contrary, such a campaign may be unsuccessful in motivation the audience into purchasing a product or peaking their interested in company services. Thus focusing on corporate image could create passive interest, which might not translate in sales, which result into lower marketing returns.…
What are Federally Qualified Health Centers (FQHCs)? It is run by the Federal Government and driven by Medicare. “The FQHC benefit under the Medicare was added effective October 1, 1991” (CMS FQHC fact sheet, n.d.). It is to ensure that all Americans regardless if they can pay for medical services is offered the same care of an individual with paying health care insurance. This service is mostly popular in the rural area of the States.…
West Florida Regional Medical Center (WFRMC) located on the north side of Pensacola, Florida competed strongly with sacred heart and Baptist hospitals for patients. WFRMC’s CEO John Kausch was an active member of the Total Quality Council of the Pensacola Area Chamber of Commerce (PATQC) (McLaughlin, C.P., Johnson, J.K., & Sollecito, 2012).. PATQC’s vision was to develop the Pensacola, Florida area into a total quality community by promoting productivity, quality and economic developments in all area organizations both public and private (McLaughlin, et, al., 2012). John Kausch’s good management skills initiated the Control Quality Improvement for WFRMC to understand and adapt the external environment, empower clinicians and managers to analyze and improve process, adapt a norm that customer preferences are important determinants in quality which includes both patients and providers in the process, development of multidisciplinary approach that exceeds beyond conventional departmental and professional lines, adopting a plan for ongoing change and adaptation, setting up mechanisms for implementation and organizational learning, and providing motivation data-based cooperation to process analysis and change (Sollecito, W.A. & Johnson, J.K., 2013).…
Contrast the Medicare method of payment for physicians with the Medicare method of payment for hospitals.…
You’re an HMO director. You would like to ensure that your managed care plan is meeting industry standards. What’s one way that you can do this? 9. You work for a third-party payer performing medical records review. Your job is to match codes that were submitted on the claim to documentation in the medical record. You notice that a code has been input for a colonoscopy procedure, but you don’t see the procedure report anywhere in the record. As the third-party payer representative, what will your action be regarding the code that was submitted on the claim form? 10. You’re reviewing reimbursement for a Medicare surgical craniotomy case. The case falls into DRG 1, which has a relative weight of 3.0970 and a geometric mean length of stay of 6.3. The hospital’s current standard reimbursement rate is $1500. Calculate the DRG reimbursement for this…
Hilltop Memorial Hospital (HMH) is respecting Long’s privacy by keeping the current position of not speaking about Long’s medical history of his mental health disorder. Depending on the state in which this occurs, the state and federal laws of privacy maybe different. In this case, “under HIPAA, the privacy rule adopted by HHS does not supersede or preempt state laws that provide a higher level of protection for the privacy of healthcare information” (Harris, 2014, p. 113). The general rule for the federal privacy rule is to protect patient health information “that identifies an individual or could be used to identify an individual” but disclosure of information is allowed in certain situations.…
With MS-DRG implementation, hospitals experienced increases or decreases in payment. Medicare no longer has a fee-for-service reimbursement policy. Nowadays, Medicare pays for the care under IPPS. Each case is assigned a MS-DRG and that MS-DRG assignment determines how much the hospital will be reimbursed. This payment reflects the average length of time that group received care as an inpatient. If a patient is discharged before the average, the hospital will see a profit; however, on the opposite hand, if a patient stays longer than average, the hospital loses profit.…
You last purchased safety shoes in December of 2015. Our reimbursement policy is one pair every two years. You would be eligible for a new pair this coming December. If the pair you have does not meet the requirements in France for some reason, you can talk with your supervisor to see if they agree. If they agree that the shoes are not adequate for the trip, have them talk to me and we will try to work something…
Reimbursement and Pay-for-Performance are at the heart and soul of every health care organization. Without money coming in there is no way to pay for the services in which are offered to the individuals that need them. The individuals that need the services are required in one way or another to provide payment for these services. Individuals’ chose the health care coverage needed and than the insurance companies develop plans to fit needs to the people. The insurance or reimbursement organizations provide the payments to the providers for health care received. This paper will define pay-for-performance, reimbursement and how this affects pay-for-performance, how organizational costs reductions impact the quality and efficiency of health care, the affects on health care providers and customers from pay-for-performance and finally the future of health care and the effects of pay-for-performance.…
Well stated. However, I cannot see nurses agreeing to the disentangling of nursing costs from patient room charges with the possibility of a salary reduction. Every nurse would like to see the patient-nurse ratio reduce, but none would be willing to pay the price with a salary cut. Even though nurses need to recognize that money drives most decisions. According to Buerhaus (2010), understanding how money flows and how to communicate the value of nurses and nursing care is an important nursing role. The nursing profession has yet to develop effective methods for determining their value in the reimbursement process. Therefore, the economic value of nursing is better understood through the use of quantified nursing data. It will be important to…