Third Party Billing Companies Essay Assignment
Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages to Order 5-10 Pages Description/Paper Instructions
Third Party Billing Companies Essay Assignment
Chapter 21
Third Party Billing Companies
Learning Objectives
Billing companies in the provider payment process
Compliance program benefits for a billing company
7 basic elements of a compliance program
High risk areas for billing companies
Duties of the compliance officer & committee
Curriculum for a compliance training course
Learning Objectives
Lines of communication between CO and employees
Disciplinary action against non-compliant employees
Importance of compliance monitoring
Options in handling misconduct & non-compliance
Introduction
Many health care providers have chosen to outsource the tedious, complex billing procedures to third party firms that specialize in preparing accurate claims, submitting them, and following through to final payment.
The largest volume of fraud and abuse complaints, violations, and convictions stem from the filing of claims for reimbursement.
The problems can arise whether the billing activities are performed in-house by the provider or outsourced to a third party.
Benefits of a Compliance Program (I)
More likely compliance with laws, payor policies, and internal guidelines
Better medical record documentation
Greater cooperation between providers and those processing health information
React faster to employee compliance concerns
Respond faster to compliance problems
Demonstrates commitment to ethical, responsible corporate conduct
Benefits of a Compliance Program (II)
Assess employee/contractor fraud-related behavior
Identify & prevent illegal, non-compliant conduct
Central source for information on fraud issues
Encourages employees to report compliance problems
Thorough investigation of possible misconduct
Improve relationship with Medicare contractor
Reduced exposure to criminal and civil penalties
Basic Compliance Program Elements
Written standards, policies, and procedures
Compliance Officer and Compliance Committee
Compliance training
Open lines of communication
Disciplinary action to enforce compliance
Monitoring compliance performance
Responding to violations and taking corrective action
Written Standards, Policies, and Procedures
Standards of Conduct
Policies and procedures for high risk areas
OIG-identified list of 17 billing company risk areas
Additional 7 risk areas regarding coding services
Special emphasis on these areas:
Claims submission process
Credit balances
Data systems integrity
Records retention system
8
Compliance Officer and Compliance Committee
Compliance Officer – full-time job, report to CEO & governing board, conduct inquiries, and review compliance-related evidence
Duties of the Compliance Officer
Compliance Committee – composition
Duties of the Compliance Committee
Compliance Training
Train employees to follow the standards, policies, and procedures
Frequency and focus of training sessions
Curriculum for general training session
Training as a condition of employment
Emphasis on marketing & financial personnel
Variety of teaching methods employed
Open Lines of Communication
Between Compliance Officer and employees
To report compliance problems or ask questions
Several different communication paths available
Anonymous reporting and no retaliation
Document all reports and subsequent investigation
Disciplinary Action to Enforce Compliance
Imposed on any persons who fail to comply
Detailed procedure for administering discipline
Range of actions depending on culpability
Fair and equitable, appropriate and predictable
Background checks on new hires
Screen for convictions and debarment
Dealing with third party agents
Monitoring Compliance Performance
Both compliance program rules and avoidance of legal and payor problems
Extent and frequency of monitoring
Embedded in organization’s routine operations
Focus on areas of high compliance risk
Numerous available data-gathering techniques
Reports to management, investigations, and corrective steps
Violations by company’s provider-clients
Responding to Violations and Taking Corrective Action
Prompt, thorough investigation to assess gravity
Several forms of corrective action
Personal interviews and document reviews
Full record of investigation compiled
Report to government authorities
Discovering violations by provider-client
Identify and return overpayments
Questions?
Organizational Planning and Goal Setting [WLOs: 1, 2] [CLOs: 2, 4, 5, 6] Prior to beginning work on this discussion forum, please read Chapter 5 in your Kinicki and Williams (2018) textbook.
You have been asked by your manager at work to train new leaders and managers about organizational planning and goal setting. For your initial post, create an outline of a training presentation including speaker notes that could be used to teach your colleagues about the levels of organizational planning.
In your training presentation outline,
Describe the three levels of organizational planning (strategic, tactical, and operational) and the kinds of goals that are usually associated with each type of planning, including notes you would use to present the information if you were teaching a group of leaders and managers.
Outline the roles and responsibilities of leaders and managers within the organization for each level of planning and associated goal setting, including notes you would use to present the information if you were teaching a group of leaders and managers.
Distinguish between the roles and responsibilities of
top leaders in the organization,
mid-level leaders and managers, and
front-line supervisors.
Explain how each group of leaders and managers contributes to the overall direction and performance of the organization through planning and goal setting, providing examples from your own experience to help illustrate your points, including notes you would use to present the information if you were teaching a group of leaders and managers.
Post your training presentation outline and speaker notes as an attachment to your discussion, and include a brief commentary in the discussion textbox that would serve as an introduction of the training presentation to the new leaders and managers (e.g., what they would learn by participating in the training session).
RUBRIC
QUALITY OF RESPONSE NO RESPONSE POOR / UNSATISFACTORY SATISFACTORY GOOD EXCELLENT Content (worth a maximum of 50% of the total points) Zero points: Student failed to submit the final paper. 20 points out of 50: The essay illustrates poor understanding of the relevant material by failing to address or incorrectly addressing the relevant content; failing to identify or inaccurately explaining/defining key concepts/ideas; ignoring or incorrectly explaining key points/claims and the reasoning behind them; and/or incorrectly or inappropriately using terminology; and elements of the response are lacking. 30 points out of 50: The essay illustrates a rudimentary understanding of the relevant material by mentioning but not full explaining the relevant content; identifying some of the key concepts/ideas though failing to fully or accurately explain many of them; using terminology, though sometimes inaccurately or inappropriately; and/or incorporating some key claims/points but failing to explain the reasoning behind them or doing so inaccurately. Elements of the required response may also be lacking. 40 points out of 50: The essay illustrates solid understanding of the relevant material by correctly addressing most of the relevant content; identifying and explaining most of the key concepts/ideas; using correct terminology; explaining the reasoning behind most of the key points/claims; and/or where necessary or useful, substantiating some points with accurate examples. The answer is complete. 50 points: The essay illustrates exemplary understanding of the relevant material by thoroughly and correctly addressing the relevant content; identifying and explaining all of the key concepts/ideas; using correct terminology explaining the reasoning behind key points/claims and substantiating, as necessary/useful, points with several accurate and illuminating examples. No aspects of the required answer are missing. Use of Sources (worth a maximum of 20% of the total points). Zero points: Student failed to include citations and/or references. Or the student failed to submit a final paper. 5 out 20 points: Sources are seldom cited to support statements and/or format of citations are not recognizable as APA 6th Edition format. There are major errors in the formation of the references and citations. And/or there is a major reliance on highly questionable. The Student fails to provide an adequate synthesis of research collected for the paper. 10 out 20 points: References to scholarly sources are occasionally given; many statements seem unsubstantiated. Frequent errors in APA 6th Edition format, leaving the reader confused about the source of the information. There are significant errors of the formation in the references and citations. And/or there is a significant use of highly questionable sources. 15 out 20 points: Credible Scholarly sources are used effectively support claims and are, for the most part, clear and fairly represented. APA 6th Edition is used with only a few minor errors. There are minor errors in reference and/or citations. And/or there is some use of questionable sources. 20 points: Credible scholarly sources are used to give compelling evidence to support claims and are clearly and fairly represented. APA 6th Edition format is used accurately and consistently. The student uses above the maximum required references in the development of the assignment. 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Structure of the Paper (worth 10% of total points) Zero points: Student failed to submit the final paper. 3 points out of 10: Student needs to develop better formatting skills. The paper omits significant structural elements required for and APA 6th edition paper. Formatting of the paper has major flaws. The paper does not conform to APA 6th edition requirements whatsoever. 5 points out of 10: Appearance of final paper demonstrates the student’s limited ability to format the paper. There are significant errors in formatting and/or the total omission of major components of an APA 6th edition paper. They can include the omission of the cover page, abstract, and page numbers. Additionally the page has major formatting issues with spacing or paragraph formation. Font size might not conform to size requirements. The student also significantly writes too large or too short of and paper 7 points out of 10: Research paper presents an above-average use of formatting skills. The paper has slight errors within the paper. This can include small errors or omissions with the cover page, abstract, page number, and headers. There could be also slight formatting issues with the document spacing or the font Additionally the paper might slightly exceed or undershoot the specific number of required written pages for the assignment. 10 points: Student provides a high-caliber, formatted paper. This includes an APA 6th edition cover page, abstract, page number, headers and is double spaced in 12’ Times Roman Font. Additionally, the paper conforms to the specific number of required written pages and neither goes over or under the specified length of the paper. GET THIS PROJECT NOW BY CLICKING ON THIS LINK TO PLACE THE ORDER
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