Required Reading: Oachs, 5th Ed, Chapter 8, pages 250-254. Cure All Hospital has
ID: 2579131 • Letter: R
Question
Required Reading: Oachs, 5th Ed, Chapter 8, pages 250-254.
Cure All Hospital has received a number of payer denials for services billed with incorrect CPT codes and revenue codes. After investigating, Jane discovered that several departments were submitting their charges using electronic source systems or paper charge tickets that had not been updated to match the billing system's charge master. Discuss what Jane should do to correct this problem and measures that should be put in place to ensure that the CDM is correct and that electronic source systems and paper charge tickets are updated. Consider the following in your analysis:
1. Give examples of charge source systems or departments submitting charges using electronic source systems or paper charge tickets (paper, electronic?)
2. What should Jane do with electronic source systems or paper charge tickets that had not been updated?
3. Should audit be performed? Should there be accountability assignment? (Why or why not?)
4. Should CDM be reviewed regularly? If so, how often and why?
5. Identify what line items should be regularly reviewed in the CDM.
6. Identify who is responsible in each department who should know the items in their cost center's charge master (CDM).
7. Identify who will be informed by the responsible departments about changes to services being performed, or supplies being used in their area.
8. Include discussion of all resources used to support CDM maintenance. Is it interdisciplinary?
This case study was developed by Oachs, 5th Ed, Chapter 8 as part of the instructor manual
Explanation / Answer
Answer: 1.
Exmaple
1. Type of Bed from which patient has discharged
2. Name of TPA from which patient has arrived.
2. Billing person who has admitted the patient.
4. Type of treatment etc.
Answer: 2.
Jane Should mainatain seprate record for Ticket which has not been updated correctly and should review frequently in order to rectify the earlier mistake and should inform resposible person about type of misteake which thet did so that he could not reapet the same mistake again.
Answer: 3.
Yes There should be proper audit. Auditor should do surprise visit in order to regularized the mistake and auditor should check sample chcek and he should implement proper audit log for electronic transaction.
Answer: 34
Yes, CDM Should proper review, it will reduce the mistake which is currently happening and it will improve the quality of work of staff.
CDM shuld conduct regular meeting with staff and understand the problem and try to control the problem.
Answer: 5.
CDM Should regulary review the ticket whcih is submiiting mannually as chances of mistake become high in mannual ticket.
Answer: 6 & 7.
CDM should firstly identify the resposible person for each department and he sould inform to them about the problem if after information the problem will not regularised then he should inform manangment and to those charged with govrenance.
Answer: 8.
Auditor, Managment, those charged with Governance and other should conduct regular meeting and understand the problem due to which problem being occure and try to regularised it.
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