Reimbursement in healthcare

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Health Medical

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Use APA format and include at least 2 references fo each question.

1. Reimbursement rules require that the chargemaster drives a facility’s charges. To receive the optimal reimbursement for services rendered, the charge master must be up-to-date and all-inclusive and must meet any payer rules and regulations.

The UMUC facility has decided to undergo a review of its chargemaster to ensure that it meets the above criteria. In addition to the comprehensive evaluation, one of the other objectives of the project will be to institute the procedures to ensure that all additions, revisions, and deletions meet the chargemaster standards. In a minimum of 250 words, respond to questions below. Discussion should contain a minimum of 2–3 peer-reviewed references.

  • How could the facility measure the success of the chargemaster review project?
  • Which facility departments should be included on the project team? Describe the role and responsibilities of each team member?
  • Who would be the most appropriate project sponsor? Who are the project stakeholders?

2. In a minimum of 250 words, explain how fee for service and capitation payment systems affect the physician’s role as the patient’s agent? Second, the move from cost-based payment for hospital services to payment on DRGs was expected to change hospital behavior. Discuss what you would have expected to observe as payment methods changed? Discussion should contain a minimum of 2–3 peer-reviewed references.

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Explanation & Answer

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Running head: REIMBURSEMENT IN HEALTHCARE

Reimbursement in Healthcare
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REIMBURSEMENT IN HEALTHCARE

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Part 1

Measuring success of the Charge master
Success of the charge master should be measured through its ability to support,
empower, and ensure departmental accountability. The prices should also be people centered
and should ensure quality of customer service in a consistent manner. Charge master file
should also be generated consistently upon demand. The charge master is faced by the risk of
inaccurateness or incompleteness. Therefore, accuracy when reflecting records to the payer
would be an indication of success. Completeness is time intensive, and therefore the ability to
achieve this completeness would indicate success. This would however require looking into
the charge maste...


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