Medicare Crossover Case Paper

The Case Management program is offered by Kaiser Permanente to support members with complex medical, psychosocial, and care management essentials. This specialized service is provided by case managers. The case managers are either Registered Nurses who are certified in case management or qualified Social Workers. Case managers provide necessary information and education to promote understanding, reduce the chance of possible complications, and facilitate effective and proper delivery of care and services.

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

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

Managed care contracts are investment assets, similar to stocks and bonds. As such these contracts need to be continually monitored and evaluated in any type of HCOs’ contracting procedures. Therefore, following factors need to be reviewed. Reimbursement rate concentrating with whether emergency service charge separated or not, the broker cannot get paid more than the provider, total discount outlier provision, clear indication of whether coinsurance to be paid by the patient is based on full charge or discounted charge, is there any special language that cannot be clarified et.al. I will focus on following structures in the given types of HCOs.

Received a call from an attorney asking for information about his client's husband. The attorney had called the SPD Branch and he was told they cannot share any information because the are prohibited by HIPAA Law. He was informed it is because the DHS workers are not allow to share information due to public assistance laws

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

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 measure by healthcare groups, eventually evolved to include federal protection of privacy with the introduction of the Privacy Rule, effective in 2001, for individually identifiable health information. This mandate established standards that dictated the use and disclosure of protected health information (PHI), and addressed issues such as administrative handling of information and the keeping of records, as well as the

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

This is a verification to your prior announcement in reference to the recent modifications that will affect our company’s eligibility for Medicare/Medicaid reimbursement by state and federal agencies. I would like to thank you for your instructive letter and will address all concerns straightaway in order to fulfill the new congressional instruction.

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.

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

Fairview attempted several times to get this claim reprocessed for payment. I was working with Maureen and I was not able to get the claim issue resolved. According to Fairview’s auditor’s the CPT code 93976 XU, denied in error. The XU modifier was implemented 1/2015 to be used with that code. Can you please advise.

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

I understand what you are saying, professor. I may have a patient that may come into my office that may suffer from anxiety that stem from a phobia like heights, but I may also be involved with another patient suffering from anxiety that stem from socializing. Patient A and patient B both suffer from similar forms of anxiety, yet both patients' anxiety are triggered from different sources. I am not sure if that is a good example, but I am sure you will let me know.

Please contact Fowler, Rachel (DCO) [mailto:rachel.fowler@hcdistrictclerk.com] in Tax Court. In regard to your figures are not matching with the given Evidence in the court. Please Make the correction ASAP and submit it to the court.