Quality and Risk Management in Healthcare Colorado College GB and PS discussions
Please complete all partsPart 1Choose one of the primary source documents from the topic list below. Using the primary source reading, answer the following questions. Use this template provided to complete the assignment.Choose one of the following documents to complete this assignmentPart 2Choose one of the primary source documents from the topic list below. Using the primary source reading, answer the following questions. Use this template provided to complete the assignment.Part 3Within the Discussion Board area, write 400600 words that respond to the following questions with your thoughts, ideas, and comments. This will be the foundation for future discussions by your classmates. Be substantive and clear, and use examples to reinforce your ideas.You are a new graduate, and you just started work at a medium-sized hospital with an attached clinic. You have been asked to review the five different types of health care insurance plans and the characteristics of each to make sure the central business office (CBO) is up-to-date on all the rules and regulations. It is important to be familiar with these plans and the characteristics of each because they play a vital role in the reimbursement process for your health care organization. Discuss the following:Part 4Within the Discussion Board area, write 400600 words that respond to the following questions with your thoughts, ideas, and comments. This will be the foundation for future discussions by your classmates. Be substantive and clear, and use examples to reinforce your ideas.Accurate coding and billing are essential to a health care facility and to a physicians financial survival. Coding is a complex task that ties to charges and revenue generation. Failure to capture all charges associated with a patient encounter can result in significant revenue loss. Medical necessity also plays a vital role in the contract with the facility or physician in terms of receiving payment from the third party payer (e.g., an insurance company).Part 1For this Discussion Board, you will define medical necessity, and you will describe the criteria to determine it.Part 2Once the patient has an established diagnosis and the services and procedures have been ordered, you will code out this information and place it on the claim for payment.It is important for health care professionals to understand this process to receive accurate reimbursement.For this part of the discussion, you will be identifying the coding systems that are utilized to support the diagnosis, services, and procedures.List and discuss the coding system that is utilized to code out the patients conditions or diagnosis. Provide an example of a diagnosis with the appropriate code as an example, and respond to the following questions:Next, identify what coding system is utilized to capture the services and procedures that the patient has received (both levels). List an example of a service or procedure with the appropriate code as an example, and respond to the following questions:Part 5Within the Discussion Board area, write 400600 words that respond to the following questions with your thoughts, ideas, and comments. This will be the foundation for future discussions by your classmates. Be substantive and clear, and use examples to reinforce your ideas.There have been some major developments in the health care industry with the evolution of managed care, patient-centered care, electronic medical records, medical necessity, stronger rules and regulations, and government intervention. You are fairly new at your job, so you have been asked to identify and review the federal regulations that impact (or have impacted) the financial management of the hospital and clinic.Complete the following for this Discussion Board assignment:Note: You must provide citations from your research.Part 6There are many reimbursement methods that are utilized to reimburse physicians and facilities for the services and procedures that they provide to patients. A physician and the facility must keep track of the services and procedures that they are providing to the patients to bill out and receive the appropriate reimbursement. The chargemaster or charge description master (CDM) is the billing process that is used in all health care facilities, and it is updated yearly.Focus your discussion on the following questions:Summative Discussion BoardReview and reflect on the knowledge you have gained from this course. Based on your review and reflection, write at least 3 paragraphs on the following:
