Case Study 13 Analysis Elizabeth Sapp University of North Carolina at Charlotte The situational analysis of Emanuel Medical Center (EMC) reveals a not-for profit independent hospital located in Turlock, California that is encountering financial troubles as it struggles to remain open. Changes in federal regulations such as the implementation of the EMTALA (Emergency Medical Treatment and Active Labor Act) laws and lower reimbursement rates for federally run insurance programs, changes in service
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Overview Overview Section 1877 of the Social Security Act (the Act) (42 U.S.C. 1395nn), also known as the physician self-referral law, or Stark Law, intends to prevent the misappropriation of or over utilization of healthcare that could result from incentivized diagnostic ordering protocols that may be a direct result of financial relationships that could influence healthcare decisions. The law is named for its author, United State Congressman Pete Stark, a Democrat from California, who authored
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company in the nation) Cost of transplants to insurers very large most insurers will outsource transplants to companies like LTNET toe ensure the best and most cost-efficient management of services * 5 phases of transplant service * Reimbursements for transplants handled differently * Initially: bundle all 5 phases together * Simplified contracting process, but rate was set more on basis of building market share than on covering costs many couldn’t even estimate the
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for one of the state’s largest Obstetric Health Care Centers. I have received word of some fraudulent behaviors in the center. I will evaluate how the Healthcare Qui Tam affects health care organizations. I will provide four (4) examples of Qui Tam cases that exist in a variety of health care organizations. I will devise a procedure for admission into a health care facility that upholds the law about the required number of Medicare and Medicaid referrals. I will recommend a corporate integrity program
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monetary fines (issued to the defendant) for addressing the crime. Currently, similar rewards remain in effect for reporting Medicare fraud and abuse. When Medicare was enacted in 1965, there was minimal federal and state oversight. Health care reimbursements were based upon the honor system. Health care providers and organizations almost immediately began to abuse the system. In the early 1970’s, Congress conducted a series of congressional investigations and hearings spanning health care fraud
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5201 “The proportion of physicians in solo and two-physician practices decreased significantly from 40.7 percent to 32.5 percent between 1996-97 and 2004-05, according to a national study from the Center for Studying Health System Change (HSC). At the same time, the proportion of physicians with an ownership stake in their practice declined from 61.6 percent to 54.4 percent as more physicians opted for employment. Both of these trends away from solo and two-physician practices and toward employment
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information, but the focus will be to explain the main contributors of telemedicine technology and the adoption of this technology by providers. The first part of emphasis of application will include technology that is utilized by hospitals, clinics and physician offices and how this technology differs depending on the setting of the provider, for example, rural hospital and developing countries. The second part of technology emphasis and its application will be to review those institutes in which use telemedicine
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In this case, each missed opportunity to report a significant, separately identifiable evaluation and management (E/M) service means a loss of anywhere from tens to hundreds of deserved reimbursement dollars per case. Three key areas of concern for modifier 25, which deals with significant, separately identifiable E/M service by the same physician on the same day of a procedure or other service claims. Radiology practices that
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Final Paper: Value‐based Care and the Physician The change to a value‐based system of healthcare reimbursement is something that I find rather daunting and somewhat scary. The traditional fee‐for‐service system, with all of its flaws, was quite simple to understand—you pay for the care that is given and if you don’t want to pay more, take care of yourself outside of the physician’s office. But, I guess my fear and apprehension about value‐based reimbursement have their foundation in not fu
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The case that I decided to speak about is the 2009 Medical Mutual of Ohio vs. Schlotterer. In this case a practicing physician was charged with being guilty of releasing sensitive patient medical records but, he made sure of all of them had physically signed what he thought would serve as an authorization to release form. So, how is it that he’s still being charged for releasing records that had a patient signature attached to it giving the authorization? It’s because “under R.C. 2317.02 (B) (1)
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