...Diabetes Working Group White Paper Avalere Health LLC on behalf of the Diabetes Working Group January 23, 2012 Table of Contents Authors.......................................................................................................................................... 3 Acknowledgments ......................................................................................................................... 4 Executive Summary ...................................................................................................................... 5 Provider Survey ......................................................................................................................... 6 Standards of Care Economic Model .......................................................................................... 7 Recommendations .................................................................................................................... 8 Care Management ................................................................................................................................ 8 Payment Reform ................................................................................................................................... 9 Workforce Supply ............................................................................................................................... 10 Background and Role of the Diabetes Working Group ............................
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...LaToya Shaw Case Study 2-Internal Control Financial Accounting 504 June 14, 2015 Internal control is very important to any company. It protects a company’s assets, can stop fraud and embezzlement. According to the authors of our book, “Internal control is a plan of organization and a system of procedures implemented by company management and the board of directors designed to accomplish the following: safeguard assets, encourage employees to follow company policy, promote operational efficiency, ensure accurate reliable accounting records, and comply with legal requirements” (Harrison, Horngreen, Thomas 2013). One of the main internal control problems that Williams Oil Services Company is doing, is allowing the receiving clerk to handle too much of the company’s inventory without proper supervision. In this case (situation a), there needs to be a separation of duties. The receiving clerk should not be in charge of the entire inventory. If she is going to order the inventory someone else should be in charge of counting the inventory received at the dock and another person should be in charge of inputting the receipts into the inventory ledger. There should also be someone in charge of reviewing the parts ordered from the receiving clerk. Having too much control in one area can cause fraud and other problems. Nicole Lopez at Scott Sales Service (situation b) is clearly violating an internal control when she is not requiring the sales team to provide...
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...Physician Reimbursement Case Case Study Discuss the general differences between facility and nonfacility rates. Discuss the MS-DRG system for hospital inpatient services. Include in your discussion the history of the MS-DRG system and the need for the updated system. There are two types of bills used in healthcare. Which type of bill is used for physician services? Which type of bill is used for hospital services? The place of service can greatly affect reimbursement, depending on the type of service provided and the location. The reason being is that Medicare typically reimburses physicians based on a method called Relative Value Units (RVUs), which has three components: work, practice expense, and malpractice. Procedures that can be performed in either a facility or non-facility setting have different practice expense RVUs, depending on the place of service. Therefore, the practice expense is a major component in rate determination, because place of service is part of this practice expense component. The practice expense component includes rent/lease of space, supplies, equipment, and clinical and administrative staff expenses. In a general sense, facilities are hospitals, skilled nursing facilities, nursing homes, or any other place that bills for Medicare Part A. Some physicians work out of a hospital owned facility, meaning that they are employed by and work in a facility owned and billed for by a hospital, and those physicians would be billing based on the facility...
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...Principles of Healthcare Reimbursement Anne B. Casto, RHIA, CCS Elizabeth Layman, PhD, RHIA, CCS, FAHIMA Copyright ©2006 by the American Health Information Management Association. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, photocopying, recording, or otherwise, without the prior written permission of the publisher. ISBN 1-58426-070-X AHIMA Product No. AB202006 Ken Zielske, Director of Publications Susan Hull, MPH, RHIA, CCS, CCS-P, Technical Reviewer Marcia Loellbach, MS, Project Editor Elizabeth Lund, Assistant Editor Melissa Ulbricht, Editorial/Production Coordinator All information contained within this book, including Web sites and regulatory information, was current and valid as of the date of publication. However, Web page addresses and the information on them may change or disappear at any time and for any number of reasons. The user is encouraged to perform his or her own general Web searches to locate any site addresses listed here that are no longer valid. AHIMA strives to recognize the value of people from every racial and ethnic background as well as all genders, age groups, and sexual orientations by building its membership and leadership resources to reflect the rich diversity of the American population. AHIMA encourages the celebration and promotion of human diversity through education, mentoring, recognition, leadership, and other programs. American...
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...Mark Cahen Health Economics HSA510 Case Assignment #2 Reimbursement Methods and Hospital Finance Dr. Rashida Biggs 02/24/2011 Good Afternoon staff, Today as I stand before you we are here to discuss our financial difficulty and ways we might be able to rise up from these hard times, First, Medicare patients whose hospital stays are paid through Diagnostic Related Groups (DRGs) which are a set of case types established under the prospective payment system (PPS) identifying patients with similar conditions and processes of care. CMS is in the process of adopting a new set of 745 Medicare Severity Long-Term Care Diagnostic Related Groups (MS-DRGs) that replace the existing 538 DRGs with ones that better recognize the severity of the illness. This was developed for Medicare as part of the prospective payment system. According to author Rick Mays, “Rather than simply reimbursing hospitals whatever costs they charged to treat Medicare patients, the new model paid hospitals a predetermined, set rate based on the patient's diagnosis. The most significant change in health policy since Medicare and Medicaid's passage in 1965 went virtually unnoticed by the general public. Nevertheless, the change was nothing short of revolutionary. For the first time, the federal government gained the upper hand in its financial relationship with the hospital industry. Medicare's new prospective payment system with DRGs triggered a shift in the balance of political and...
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...Tuition Reimbursement is a viable option that our company should look at as a means of giving our employees a way to advance their education and their positions in our company. This company was built by people and it is in those people that we should invest in, nurture and show that we are committed to their success not just here but in their life success. Often times companies look outside of their own ranks to hire people with advance degrees or more experience when there should be people here that get promoted so that growth my begin from the entry level as it should like the roots of a tree. Many of our employees are not satisfied in the positions they are in but this is not to say they are not satisfied with the company but they want more from themselves as individuals. Our profits show that we have employees that are committed to us, now it is time that we show that we are committed to them and their future. There are opportunities right now within our organization that our own employees would not qualify for without a degree, most of whom have the experience but are being held back because they do not have the one thing that would make them more hirable. As the company grows and new positions become available our employees would also like the opportunity to grow with the company as well, but in most cases with the rising costs of college it becomes almost impossible to better yourself. In todays job market our employees need all the help they can to compete with...
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...Parker What is Tuition Reimbursement? Simply put, Tuition Reimbursement is a program many companies offer to their employees in which the company reimburses some or all of the tuition fees their employees spend on education. Tuition Reimbursement is a classic win-win scenario. The company gets a better trained, more educated, and often more loyal employee, while the employee receives a subsidized education that may achieve a personal goal and without doubt makes them more marketable in the workforce. Some programs offer reimbursement for books, other expenses, and even a bonus once the employee receives his or her degree. Should we offer tuition reimbursement to our employees? The answer is simple. Yes, we should offer tuition reimbursement to our employees. Starting a tuition reimbursement program is a good idea for both the employee and employer. By helping our employees better themselves we are also helping our company by having more educated employees. We are also creating a more loyal employee. They are less likely to leave the company when they are in a tuition reimbursement program and are more loyal to the company afterwards. We also could attract the best available prospective employees with such a benefit. There is a lot of competition out there vying for the best young employees and we certainly would like to remain competitive in our recruitment efforts. Some examples of companies that offer tuition reimbursement are as follows: J.M. Smucker...
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...Pay-for-performance Reimbursement and pay-for-performance are the heart and soul of every organization. Without money flow into the health care system, it is hard to pay for the services offered to individuals. Client has to pay for the health care services utilized in one way or other. Health care system is growing in a faster pace with than the economy in the United States. The various reasons are technology proliferation, new medications in business, research studies, advances in devices, and new procedures. On the other side, there is widespread concerns about the medical errors, inconsistent quality in health care services, increase in cost, and public awareness about the health care services through Medias, led to the movement of pay-for-performance. This emerged as a cost containment program. Health care system is trying to provide quality, efficiency, accountability, and transparency in health care services through the development of pay-for-performance movement (Henley, 2005). Pay-for-performance refers to the financial incentive program that pay a bonus to the participant of services such as physicians, hospitals, physician groups, or health plan groups who attain a benchmark in quality, efficiency, accountability in health care services and in patient care. This is referred as the pay-for-performance movement. This program provides high credit bonus for preventive care services. As the term indicates, "pay-for performance" is the high quality health care services...
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...Goals Management Information System Concepts II. BACKGROUND INFORMATION . . . . . . . . . . . . . . . 12 The Manual System Program Alternatives III. DEVELOPMENT OF THE PMIS . . . . . . . . . . . . . . . . 29 The Model System The New Design The Reporting System IV. A SECOND ANALYSIS . . . . . . . . . . . . . . . . . . . . . . . . 40 Governmental Behavior PMIS Behavioral Analysis Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . APPENDIX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 ENDNOTES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 BIBLIOGRAPHY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 End of Page ii Begin Page 1 INTRODUCTION By December 1975, the Suffolk County unemployment rate reached 9.7 percent. There were over 18,000 public assistance cases; up 3,300 cases or 22.4 percent from December 1974. This represented 57,300 adults and children on public assistance. The total eligible Medicaid population, which includes both public assistance and non-public assistance cases, increased from 72,847 in December 1974 to 80,485...
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...Chapter 7 Billing Schemes Case Study Frequent Flier’s Fraud Crashes 1. Citation: Frequent Flier’s Fraud Crashes 2. Broad Issues: Expense reimbursement schemes, as the name occur when employees make a false claims for reimbursement of fictitious or inflated business expenses. 3. Identify individuals involved & their positions in this matter: Marcus Lane: 35 years old Ph.D. Traveled all over his North and South America for his job as a geologist for the privately held firm specializing in environmental management and engineering services at regional office to Tyler & Hartford. He broke a basic ruled ethics: Never cheat on your expense report. Heidi Mcllough: An account who worked at Tyler Harford’s East Cost Headquarters, Who discover Lane Transgression. Tina Marie Williams: Manager of the internal audit department. 4. Brief description of the situation (may have to Factor). In this case the Regional office of Tyler’s Hartford fell victim to fraud that was reformed as a billing scheme by Marcus Lane. 5. Describe the Fraudulent activity. Marcus Lane, who bought two different air lines tickets for two different prices. On with high price departure at 6:15 p.m. and another on for low price departure at 6:15 a.m. he return the airline tickets with the high price and kept the one with low price, but when it is time to reimbursement he decided to give the company a copy from flight that has a higher price that had been indicated a departure...
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...Bangor Family Physicians Case Study Executive Summary & Stakeholders Bangor Family Physicians is a partner based medical group practice located in Maine. The practice consists of four family practice physicians, and a medical support staff. The medical support staff is made up of a practice manager, two receptionists, four nurses, two medical assistants, two billing clerks, and a laboratory technician. Additionally, Bangor Family Physicians employs a CPA to assist with taxes and financial advising. The key stakeholders are the four family physician partners, in which each physician holds an equal stake in the practice. Bangor Family Physicians Reimbursement There are two determinants to reimbursement for Bangor Family Physicians: a monthly salary and yearly profits after accounting for reinvestments into the company. Since the foundation of Bangor Family Physicians in 1986, the practice has used an equal pay compensation model as the reimbursement scheme of choice. Profits that are above overhead costs at the end of the year are portioned out equally to each partner, thus determining the overall amount the physician receives for the year. While this type of compensation model discourages overutilization and allocates risk among all physicians, it negatively affects productivity and does not reward efforts to improve quality. Such a system can only work on the basis that all physicians have the same skill and productivity levels and are equally motivated to contribute...
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...Week 1 Case Study 1. Candidate 1 a. Strengths – 1. Bachelor’s degree in Health Administration 2. 3 years on the job 3. Increased reimbursements 4. Well with technology with innovation and entrepreneurial 5. Directive management style 6. Goal oriented b. Weakness 1. Pompous and opinionated 2. Feels no one know as much about technology like she does 3. Pushes employee to hard Candidate 2 1. Strengths – 1. Bachelor’s Degree in Health Administration 2. Master’s in Business administration 3. 5 years on the job 4. Talented negotiator 5. Good with people Wants to lead, direct and manage employees 6. Participative management style 7. Professional demeanor 8. High integrity 9. Willing to work overtime b. Weakness – 1. Not at the center on a daily bases 2. Rumors about attend on the clock without permission Candidate 3 A. Strengths – 1. Bachelor’s degree in Health administration 2. Confident and professional 3. Positive and motivated 4. Can oversee large groups of employees 5. Increased reimbursements 6. Good at teaching and training instrumental in the purchases and installation of billing system 7. Liked by the employees 8. Good...
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...CVS Web Strategy Case Analysis Brandon Matthews 9/30/2009 1 Overview Introduction Consumer Value Stores, better known as CVS opened its doors in 1963 as a health and beauty supply store in Massachusetts. Since then it has evolved to one of the largest retail pharmacy chains in North America. In 1999, CVS was faced with a new business strategy. It appeared that there was a lot of traffic on Wall Street involving online pharmacies. The consumer and stakeholder demand for a strategic web presence for companies, with no exception of pharmacy giants like CVS, pressured the executives to implement a business strategy of incorporating its pharmaceutical retail services with the web. Helena Foulkes, Vice President of Marketing at CVS, was charged with ensuring that this new business strategy succeeded. CVS acquired a web company, Soma.com whose entire business strategy was similar to what CVS was attempting to achieve. Foulkes was faced with critical strategic challenges in transforming their new Information Technology (IT) initiative, Soma.com, to CVS.com. In this paper, we will introduce the retail pharmacy industry and its protagonists, achieve a bird’s eye view of CVS’s organizational structure, understand who CVS’s customers and competitors are, introduce the term Alignment Link in terms of overall strategy, implement the SWOT analysis tool to gauge ...
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...Huntsville Hospital Health System develops pricing strategies within the organization to provide specific services, products, and pharmaceuticals, while covering organizational costs and producing revenue. Healthcare organizations employ prices, one element of the marketing mix, in addition to combining payer mix, service mix, capital demands, and charitable cases for consideration in pricing strategies within a healthcare system (Feldman, 2002). In healthcare, pricing strategies are affected by multiple factors like managed care, pharmaceutical and medical device companies, and in recent years increased government involvement. Pricing must ensure that the Huntsville Hospital Health System covers all it’s financial needs, while cost represents a single component of pricing. Healthcare pricing encompasses charges set by the hospital to not only pay for the cost of an item, but to pay for the staff delivering the product, the electricity, marketing, and other supplies. HHHS provides excellence in providing a...
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...Reimbursement and Pay for Performance Kristi Thomas Health Care Organizations and Delivery Systems HCS/531 August 11, 2014 Nita Magee-Cornelius Pay for performance is a slogan that is used lightly in 2014. It seems to be a no-brainer, when we pay for services we pay for quality and not quantity. It is a bit more complex than that. The slogan actually is a reimbursement or initiative program that provides financial incentives to hospitals, physicians, and other health care providers to make improvements to and achieve optimal outcomes for their patients. The outcomes are measure and some health care providers are paid more because they are deemed to have delivered better service or their patients appear to have better outcomes. There is a controversy amongst intellectuals that ask the question “How can the quality of care be measured?” The idea behind pay for performance is simple; we will give providers more money to achieve a goal. This paper will discuss how reimbursement is affected by this pay for performance initiative, how system cost reductions can impact the quality of care, how pay for performance can affect the provider and what type of effect it will have on the future. In the following paragraphs it will be discussed whether or not reimbursement is affected, how the system costs reductions impact the quality and efficiency of health care, how pay for performance affects the health care provider and their customers and the effects that the pay for performance...
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