Determine the reimbursement for medicaid

Reference no: EM131386789

Research Paper

Search course materials, including your text and the Internet, to find a spreadsheet program that will assist you in completing this assignment. The spreadsheet and calculations are to be attached at the end of the paper as an appendix after the Reference page.

Case Study: You are assessing the payer-patient mix for a health care organization. Currently, your payer mix is 40% Medicare, 10% Medicaid, 25% traditional indemnity insurance, 20% managed care, and 5% self-pay patients. Complete the following:

Using the most common office visit, CPT code 99214, determine the reimbursement from the Centers for Medicare and Medicaid Services (online fee schedule available for Medicare).

Using the same CPT code, 99214, determine the reimbursement for Medicaid (fee schedules should be available from the individual state).

Using the same CPT code, 99214, create at least 3 other traditional indemnity insurance reimbursements. If possible, use the actual reimbursement from the insurance carrier. It may be possible to obtain actual reimbursement information from your personal insurance carrier. If the information is not available, assume reimbursement by traditional indemnity insurance is usually 200% reimbursed more than Medicare and Medicaid, and managed care is usually 133% more than Medicare and Medicaid.

Compose an accounts receivable benchmark from this information showing columns for current, 30-60, 61-90, 90-120, and greater than 120 days.

Assess the information for areas of improved reimbursement of at least 20% or more.

Evaluate the options available to change the payer-patient mix with consideration of related legal and ethical issues.

Propose a best strategy with justification and rationale based on effective decision-making tenets.

The body of the resultant paper should be 10-12 pages. Spreadsheets demonstrating the accounts receivable analysis will be attached as appendices, and there will be at least 7 relevant peer-reviewed academic or professional references published within the past 5 years. Also attach appropriate fee schedules.

Reference no: EM131386789

Questions Cloud

Find three health care management positions : Find three health care management positions. Create an original internal and external job posting for North Valley Medical Group. Based your posting on what we've covered in this module, along with what you've observe on the job postings that wer..

Do computer scientists require the isp to practice : Do Computer Scientists require the ISP to practice? What are the advantages of the ISP?

Is given instrument negotiable : The holder of this instrument shall have the election to require the assignment and delivery to him of my 100 shares of Brookside Iron Works Corporation stock in lieu of the payment of Five Thousand Dollars in money. (Signed) Sam Sharpe Is this in..

Write a response about the given post : It is true that both non-for profit and for-profit hospitals provide charitable services. It is my opinion, that non-for-profits provide more charitable healthcare services than for-profits. I believe this is so for 2 reasons the first is that the..

Determine the reimbursement for medicaid : Using the most common office visit, CPT code 99214, determine the reimbursement from the Centers for Medicare and Medicaid Services (online fee schedule available for Medicare).

Explain is the note negotiable : if I fail to pay the first installment on the due date, the entire sum shall become immediately due. (Signed) Henry Brown Is the note negotiable? Explain.

Define the relationship between culture and technology : Define the relationship between culture and technology and show three examples of this relationship either in history or around us today.

Descreibe why you agree or disagree with your results : Explain why you agree or disagree with your results. Develop strategies to advance your career using your strengths. How can you use goal-setting to increase motivation and improve job performance?

Decisional statement and a looping structure : What is the difference between a decisional statement and a looping structure? Which one includes increment or decrement operators and what is their function?

User Account

All Pages