Question
Financial Compliance- You have been hired on a consulting project by Alpha Hospital who was recently cited for inappropriate physician billing practices. After study, it
Financial Compliance- You have been hired on a consulting project by Alpha Hospital who was recently cited for inappropriate physician billing practices. After study, it was learned that both the Hospital and the hospital-owned Alpha Physician Group billed Medicare for the physician fee for cardiac Electrophysiology (EPS) procedures. It is not lawful for two organizations to double bill the physician portion to Medicare. The hospital bills the hospital fee to Medicare. Either the hospital or the Physician Group can bill the physician fee, not both. Please consider the issue and design a brief plan for who will do the billing in the future and how a compliance program will be developed to monitor the billing for compliance. Describe the organization changes; the education changes; the billing changes; and the compliance changes. Research and outline what data and metrics would be essential in the billing and monitoring.
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