Three Main Components in Preparing Your Final Portfolio
Order ID:89JHGSJE83839 Style:APA/MLA/Harvard/Chicago Pages:5-10 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
Excellent Quality
95-100%
Introduction 45-41 points
The background and significance of the problem and a clear statement of the research purpose is provided. The search history is mentioned.
Literature Support
91-84 points
The background and significance of the problem and a clear statement of the research purpose is provided. The search history is mentioned.
Methodology
58-53 points
Content is well-organized with headings for each slide and bulleted lists to group related material as needed. Use of font, color, graphics, effects, etc. to enhance readability and presentation content is excellent. Length requirements of 10 slides/pages or less is met.
Average Score
50-85%
40-38 points
More depth/detail for the background and significance is needed, or the research detail is not clear. No search history information is provided.
83-76 points
Review of relevant theoretical literature is evident, but there is little integration of studies into concepts related to problem. Review is partially focused and organized. Supporting and opposing research are included. Summary of information presented is included. Conclusion may not contain a biblical integration.
52-49 points
Content is somewhat organized, but no structure is apparent. The use of font, color, graphics, effects, etc. is occasionally detracting to the presentation content. Length requirements may not be met.
Poor Quality
0-45%
37-1 points
The background and/or significance are missing. No search history information is provided.
75-1 points
Review of relevant theoretical literature is evident, but there is no integration of studies into concepts related to problem. Review is partially focused and organized. Supporting and opposing research are not included in the summary of information presented. Conclusion does not contain a biblical integration.
48-1 points
There is no clear or logical organizational structure. No logical sequence is apparent. The use of font, color, graphics, effects etc. is often detracting to the presentation content. Length requirements may not be met
You Can Also Place the Order at www.collegepaper.us/orders/ordernow or www.crucialessay.com/orders/ordernow
Three Main Components in Preparing Your Final Portfolio