Recovery Audit Contractor Program Essay examples

HIM Personnel play an important role in the Medicare system. Medicare has transitioned from “fee for service” to providing incentive payments for providers that issue high quality care at affordable prices. In order to achieve the “pay-for-quality” incentives hospitals and health care officials must improve their documentation processes. “If it isn’t documented, it wasn’t done” is more important than ever. It is the responsibility of the HIM professional to ensure the integrity of the patient chart. HIM professionals monitor the quality of documentation and ensure all clinical documentation is complete and accurate. HIM professionals are the key to identifying process problems while keeping in mind patient safety, quality of care, and revenue integrity. Medicare requires that hospitals report quality improvement measures in order to receive payments; HIM professionals can directly impact Medicare incentive payments. HIM professionals are directly involved with the Medicare Audit Improvement Act. The HIM professional collects health data that is subject to the audits; HIM professionals are the point of contact for responding to Medicare audit requests.

The Recovery Audit Programs (RAC) is to identify any Medicare collection that is under any detection and collection of overpayments that are made on claims of health care services that are provided by Medicare beneficiaries, and to identify any payments that are provided so that CMS can take any actions that can prevent future improper payments in all 50 states. RAC programs is a successful program that utilizes the recovery Audit to identify ant Medicare overpayments and underpayments to health care provider to suppliers in selected states. The demonstration that has been ran between 2005 and 2008 has resulted in over $900 million in overpayments that has been returned to the Medicare Trust Fund and there has been $38 million in underpayments that has been returned to the health care providers. This has resulted in Congress to require the Secretary of the Department of health and Human Services to have a permanent and national Recovery Audit programs to help on overpayments that are associated with services for which payment are made under Medicare part A or B Which is the Social Security Act. For every Recovery Audit has a responsibly to identify any overpayments and underpayments that is within ¼ of the country.

9. The review of systems (ROS) is documented for patient care purposes and also factors into the ________________ for the patient 's visit.

"Medical coding professionals provide a key step in the medical billing process. Every time a patient receives professional health care in a physician’s office, hospital outpatient facility or ambulatory surgical center (ASC), the provider must document the services provided. The medical coder will abstract the information from the documentation, assign the appropriate codes, and create a claim to be paid, whether by a commercial payer, the patient, or CMS." (Aapccom, 2015) It is very important that billing coders have a full understanding of how to properly use medical codes to prevent denial of claims submitted.

On October 1, 2013 CMS has implemented a two midnight rule. If a patient is not in the hospital over two midnights the claim will not be eligible for payment under Medicare Part A (Pahuja, 2014). The physician must document and prove necessity for a two night stay. The American Hospital Association and three hospitals have sued Medicare based on ethical standards of RAC. The claim is that RAC auditors are paid based on the funds recovered from hospital audits. The push to pay auditors a flat fee, eliminating the unsubstantiated over riding of a physician decision in order to increase the amount of dollars

in order to obtain stronger or more persuasive evidence, the “bank balance” reported by the

| Our firm - Chiu & Weisserman LLP has been appointed as the new auditor of the public company Dollarama Inc. for the current fiscal year-end as at January 29, 2012. Please find in the following pages a report on the audit plan that was used to conduct our audit for the year ended January 29, 2012. Even though the audit of 2012 was performed by PWC, the assumption used for this project was that our firm was the new auditor for 2012.

A Fixed Price contract provides for a price which normally is not subject to any adjustment unless certain provisions are included in the agreement, such as contract change, economic pricing, or defective pricing. These contracts are negotiated usually where reasonably definite specifications are available, and costs can be estimated with reasonable accuracy. A

1. Name and briefly describe each of the two basic types of competitively bid construction contracts. Which type would be most likely used for building the piers to support a large suspension bridge. Why?

In the present day forensic accounting plays a huge role in many of the court cases publicized by the media. With the spotlight on the profession, this is a good opportunity to discuss the following topics:

The health care industry exist to provide preventative measures, diagnose health conditions, repair, and provide services to improve the quality of life. The cost of health care continues to rise each year. Health care fraud is a factor that continues to plague the health care industry. The affect health care fraud has on hospitals, is the increasing cost of medical services. The following research will examine and evaluate how organizational structure and governance, culture and the lack of focus on social responsibility affects on health care fraud. The following research will also include recommendations for prevention of health care fraud, recommendations for

Performance reviews are intended to encourage changes in behavior, encourage career development, and support continuous organizational learning. These reviews focus on social and technical contributions the individual contributed to the project team. For example, the 360-degree feedback process has been used successfully to improve the ability of people to work on teams. As long as performance reviews are not directly related to pay and promotion decisions, such reviews are more readily accepted and even perceived as positive for the individual and organization.Since pay reviews can result in negative or positive outcomes for a career, they are perceived as very serious by most individuals. Pay reviews should be more carefully structured and based on clear standards and criteria known to the person being evaluated. Every attempt should be made to avoid confrontation. 4. Advocates of retrospective methodology claim there are distinguishing characteristics that increase its value over past lessons learned methods. What are they? How does each characteristic enhance project closure and review? * Uses an independent facilitator. The facilitator is held responsible for identifying and implementing lessons learned. Independence encourages gaining more information from stakeholders. * Includes a minimum of three in-process learning gates during the life project cycle. These gates catch problems and success

In today's business it is in the best interest of companies to have project managers. Common sense isn't always easily accomplished. Anyone who's ever worked on a project in a technical setting knows this. Indeed, much of working with others consists of solving unexpected problems and learning from mistakes along the way. Knowing this and having the proper tools a project manager will be able to manage and complete the most intense project out there.

Moreover, this further supports our recommendation for Atlantic to proceed with this acquisition as it will obtain one of the best mills for a cheap initial cost ($319m compared to the construction cost of $750m).

If you are thinking about starting your own business you may also be considering building from scratch. When it comes to building your own business you really do have a lot of options available to you. Most people will get a loan in order to cover the cost of building the new business. Since you are not building a home a regular mortgage will not be an option for you in this case. You will basically want to look into a new construction loan. New construction loans are basically short term loans that will help you to build your business literally from the ground up. You should keep in mind that these types of loans do carry a very high interest rebate, although in some cases you may be able to get a good deal which would lower the interest rate for. One thing that some people fail to take into consideration is the fact that you will have to make some payments during the construction phase. Some people fail to do their research and find this out the hard way. So don 't think that once your business is up and running then you will have to start payments. You will have to start making the payments even before the materials for your building arrive. One thing that you will want to avoid is getting a new construction loan online. Of course by doing this you will be making the process easier, but you will not have the opportunity to ask as many questions as you should. Remember building your own business is a big step so you want to make sure that you are clear on everything