Image transcription text 2 Q Window Help uny.edu/webapps/blackboard/content/listContent.jsp?course_id=_2236889_1&content_id=_71913 3 8 0 6 9 010 . CASE STUDY
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Vindow Help uny.edu/webapps/blackboard/content/listContent.jsp?course_id=_2236889_1&content_id=_71913 CASE STUDY FRAUD AND ABUSE 2021-Saved to my Mac Tell me Layout References Mailings Review View EE n 0 X X ' ' 9 F4 V Aa v AA English (United States) 3 DOCS R US MINI CASE STUDY A % 5 T G F5 B tv A 6 Y F6 FO H MacBook Air This Case Study Relates to Chapter 16 Fraud and Abuse and 7 PERFORMANCE IMPROVEMENT M Fraud, abuse and waste in Medicaid cost states billions of dollars every year, diverting funds that could otherwise be used for legitimate health care services. Not only do fraudulent and abusive practices increase the cost of Medicaid without adding value - they increase risk and potential harm to patients who are exposed to unnecessary procedures. In 2015, improper payments alone which include things like payment for non-covered services or for services that were billed but not provided-totaled more than $29 billion according to the Government Accountability Office. While Medicaid fraud involves knowingly misrepresenting the truth to obtain unauthorized benefit, abuse includes any practice that is inconsistent with acceptable fiscal, business or medical practices that unnecessarily increase costs. Waste encompasses overutilization of resources and inaccurate payments for services, such as unintentional duplicate payments. As states look for innovative ways to contain burgeoning Medicaid costs and promote the program's integrity, fighting fraud and abuse offers one approach that everyone can support. The Vice President of Compliance in a 440 bed inner city hospital received a message on the Compliance Hot Line that a Billing Clerk was upcoding the admitting diagnosis of all patients admitted through the emergency room. An example was a 38 year old female Medicaid patient originally diagnosed with a mild gastrointestinal problem was upcoded to colitis eligible for a reimbursement of $400 vs. a triage reimbursement of $150. Upon investigation, it was found that the Billing Clerk was upcoding. & 7 U ASSIGNMENT: In a two page single spacedyped paper 1. Identify the issue; 2. Referring to the textbook how Focus G F7 J * 0 2 8 A DII F8 I AaBbCcDdEe K ( 9 Normal F9 O AaBbCcDdEe No Spacing L ) 0 A F10 P > E Styles Pane 4 F11 LE { [ + 11 Share Dictate Vindow Help uny.edu/webapps/blackboard/content/listContent.jsp?course_id=_2236889_1&content_id=_71913 CASE STUDY FRAUD AND ABUSE 2021-Saved to my Mac Tell me Layout References Mailings Review View EE n 0 X X ' ' 9 F4 V Aa v AA English (United States) 3 DOCS R US MINI CASE STUDY A % 5 T G F5 B tv A 6 Y F6 FO H MacBook Air This Case Study Relates to Chapter 16 Fraud and Abuse and 7 PERFORMANCE IMPROVEMENT M Fraud, abuse and waste in Medicaid cost states billions of dollars every year, diverting funds that could otherwise be used for legitimate health care services. Not only do fraudulent and abusive practices increase the cost of Medicaid without adding value - they increase risk and potential harm to patients who are exposed to unnecessary procedures. In 2015, improper payments alone which include things like payment for non-covered services or for services that were billed but not provided-totaled more than $29 billion according to the Government Accountability Office. While Medicaid fraud involves knowingly misrepresenting the truth to obtain unauthorized benefit, abuse includes any practice that is inconsistent with acceptable fiscal, business or medical practices that unnecessarily increase costs. Waste encompasses overutilization of resources and inaccurate payments for services, such as unintentional duplicate payments. As states look for innovative ways to contain burgeoning Medicaid costs and promote the program's integrity, fighting fraud and abuse offers one approach that everyone can support. The Vice President of Compliance in a 440 bed inner city hospital received a message on the Compliance Hot Line that a Billing Clerk was upcoding the admitting diagnosis of all patients admitted through the emergency room. An example was a 38 year old female Medicaid patient originally diagnosed with a mild gastrointestinal problem was upcoded to colitis eligible for a reimbursement of $400 vs. a triage reimbursement of $150. Upon investigation, it was found that the Billing Clerk was upcoding. & 7 U ASSIGNMENT: In a two page single spacedyped paper 1. Identify the issue; 2. Referring to the textbook how Focus G F7 J * 0 2 8 A DII F8 I AaBbCcDdEe K ( 9 Normal F9 O AaBbCcDdEe No Spacing L ) 0 A F10 P > E Styles Pane 4 F11 LE { [ + 11 Share Dictate
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Identifying the Issue The issue in this case study involves the discovery of upcoding by a Billing Clerk in a 440bed innercity hospital Upcoding refer... View the full answer
Related Book For
Understanding Basic Statistics
ISBN: 9781111827021
6th Edition
Authors: Charles Henry Brase, Corrinne Pellillo Brase
Posted Date:
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