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Analyze the impact of the False Claims Act on the organization’s reimbursement, coding, and strategic planning
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- Discuss the intetactive process helping client. Documentation and reporting. Purpose of client records, types of records.briefly describe a strategic planning, staffing impact, reimbursement compliance and revenue cycle process in healthcare reimbursementTo process claims accurately and effectively, billing professionals must understand how a clean claim is prepared and what issues can contribute to a dirty claim. When managing a team of billing professionals, it is important to understand how internal and external factors contribute to a smooth process vs. a rejection or denial. Summarize internal factors (within your organization/facility) that can positively or negatively influence the life cycle of a claim. Summarize external factors (outside of your organization/facility) that can positively or negatively influence the life cycle of a claim. From a leadership perspective, how can you ensure your team is effectively trained and confident in navigating internal and external challenges with claim processing? Please be sure to validate your opinions and ideas with citations and references in APA format.
- how can laws and regulations help a healthcare organization reduce fraud, waste, and abuse and thereby manage risk to the revenue cycle and reimbursementWho is responsible for overseeing the risk management and quality assurance programDescribe in great detail the Medicaid reimbursement process for providers and program integrity efforts to stop fraud using references from the past 5 years.
- How is compliance to regulatory requirements in healthcare reimbursement built into the back-end processesWho would be impacted by such events claims production and claims submission in healthcare?The Physician Self-Referral Law, also known as the “Stark Law,” generally prohibits a physician from making referrals to an entity for certain healthcare services, if the physician has a financial relationship with the entity. How can a physician get around the Physician Self-Referral Law?
- How can a statement of need is important to address cyberattacks in healthcare organizationsWhat are two ways a healthcare provider could violate the HIPAA law, and what are alternative actions the healthcare provider could use to protect client confidentiality?The hospital outpatient pharmacy wants to begin furnishing medication therapy management services for its patients. They intend to meet with patients face-to-face, provide documentation of a pharmacist review of patient history, establish a thorough medication profile, provide consultation to patient about improving treatment outcomes and compliance.Based off of this description, which codes should the hospital outpatient pharmacy use to capture the services of its pharmacists?A. 99605-99607B. 99487-99489C. 99601-99602D. 99401-99409