Medicare Crossover Case Paper

Case Study #6 Managerial Accounting #1 With no change in volume (utilization), is the clinic projected to make a profit?

Overview Big Bend Medical Center is a full-service, not-for-profit, acute care hospital with 325 beds located in Big Bend, Texas. The bulk of the hospital’s facilities are devoted to inpatient care and emergency services. (Gapenski, pg. 27) The outpatient services section of the hospital is used by the Outpatient Clinic, as well as the Dialysis Center. The Outpatient Clinic, which makes up about 80 percent of the outpatient services section, has recently grown in volume and has created a need for 25 percent more space than it currently has. Moving the Dialysis Center to a new building was decide to allow expansion of the Outpatient Clinic. A change and focus on the allocation of costs has some department heads angry and claiming of

Rather than having the other claims adjusted, the provider insisted that we not look into the matter further because they did not want us to take back any money. Sadly this is just one example of fraud; it is not uncommon to see providers change the coding of claims to get something that they know should not be paid to process for payment. Cracking down on this type of fraud will reduce the amount of money paid out on claims by insurance carriers. Since claims payments directly affect the cost of insurance, this will also help in lowering premiums.

Allied HealthMedicare Appeals ProcessReimbursement and CollectionsPage 1 of 2Lab Assignment Medicare Appeals ProcessPart 1It's important to note differences in the Medicare Appeals Process. First, take some time to review the following PDF document and explore the process and its distinct characteristics.Medicare Parts A and B Appeal ProcessPart 2Once you have read through the file, write one-to-two paragraphs below, describing the following:Differences in the processReasons why appeals are escalated from one level to the nextQuestions you have about the processThere are a few differences between the 5 different levels in the appeal processes. You must go through each level to proceed to the next. In the

Medicaid is a cooperative program administered by federal and provincial government that insures individuals with chronic illness or disabilities who could not have had the means to obtain insurance elsewhere. However, Medicaid’s ability to run efficiently has started to be questioned due to growing budget pressure. This program is need of improvement, so it can benefit both the people and the country. Medicare faces its challenges too, as the population of elderly grows, so does the cost of the program. The coverage of Medicare is also questionable. The government covers about 60% of the medical expenses under Medicare, however 15% of Medicare recipients are so indigent that they would be entitled to Medicaid. Money is also the problem for

Additionally, the penalties that were assessed within this case was based on the compliance of the policies and procedures of the HIPAA laws and was settled against Rite Aid by the rights of health information privacy. “Jill Granger and Laura Cataldo (2013) reports this standardization, originally suggested as a cost-saving

Forrest I spoke with Ingrid this evening about the offer contract for Jared Carroll over at Littleton Adventist Hospital. As per Ingrid, this facility goes part of Centura Health which is part of MedAssets. You will need to contact the Program Manager over at MedAssets for an increase on the bill rate. Please partner up with her in the morning and see if we are able to get something

This is a follow-up email in reference to your question for Authorized to Offer Medicare Supplement plans.

Just an FYI, escalation#1580 is not a true escalation. Claim#124210654800 had an appeal sent back on 05/05/2015 appeal# APP-1186293. I understand that the appeal was dismissed because of the rep. didn’t note the document ID#. But we must understand that this is the first level of appeal. Once the appeal has been closed out, the provider must send in a 2nd level appeal. I’m not sure, if you advise the provider that the submission of your escalation doesn’t halt the timely filling of the 2nd Level. Which has now passed. Going forward, please be sure to review the appeal to determine if it is a true escalation or not. This can be based on discrepancies in the discussion based off the reason why the appeal was sent back. For this escalation, I

Reason For Refund: Mr. Angioni purchased a expedited Supreme Court Certificate of Good Standing for his sister Nannina Angioni on 1-10-2017. The order was received in our office and then sent over to the Supreme Court by email for processing that same day. Mr. Angioni contacted our office today saying they still have not received the order for his sister. We contacted the Supreme Court to see what happen to the order and will update the member as soon as we hear back. Mr. Angioni requested for us to issue an refund for the expedited cost for the certificate since they did not get it within our order time frame. Please refund $10.00 to Mr.Angioni's credit

We received notice that Aetna has denied our LifeVest claim for Ms. Sanders’ due to ZOLL being an Out-of-Network provider. Please consider this a formal appeal requesting an exception to reprocess Ms. Sanders’ claim using her In-Network benefits. Because ZOLL is the SOLE Manufacturer/provider worldwide for the FDA Class

Once the claim status has been determined, take any necessary action needed to facilitate the prompt remittance of said claim. Insurance companies use a number of stall tactics to hold back payment as long as possible. I bet if providers charged them interest for wrongly

The DCF uses the present value of the estimated free cash flows of a company which are then divided by the number of shares outstanding to find the stock price of the company. This model requires many assumptions to be made. Martin used a Terminal multiple of 13 times and a weighted average cost of capital of 9.3% and found a stock price of $54.29.

I am writing to dispute a billing error on my account in the amount of $96.54. I believe the amount is inaccurate because according to my insurance Explanation of Benefits forms, I have a paid the amount allowed for this procedure. I am requesting that the error be corrected and that I receive an accurate statement.

Teri, I still have not received a response from either you or Meggie. I cannot stress how important this is to resolve this issue asap. We have over half a million dollars that are owed to us and we want some action. But, more importantly, as