Physician Reimbursement Case

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Jackeline S Gonzalez BUS5651 - Healthcare Policy Term: Spring 2 2012 Week 2: Case Study Physician Reimbursement Case Discuss the general differences between facility and non-facility rates. Discuss the MS-DRG system for hospital inpatient services. Include in your discussion the history of the MS-DRG system and the need for the updated system. There are two types of bills used in healthcare. Which type of bill is used for physician services? Which type of bill is used for hospital services? Abstract The health care delivery system of today has undergone tremendous change, even over the relatively short period of the past decade. Health care utilization also has evolved as the population’s need for care has changed over time. The growth of managed care and payment mechanisms employed by insurers and other payers in an attempt to control the rate of health care spending has also had a major impact on health care utilization. Efforts by employers to increase managed care enrollment, as well as major Medicare and Medicaid cost containment efforts such as the Prospective Payment System for hospitals and the Resource Based Relative Value Scale for physician payment, created incentives to shift sites where services are provided. Clinical documentation in the health record is critical to the patient, the physician, and the healthcare organization. Hospitals, in particular, have become more dependent on physician (provider) documentation in order to comply with the Centers for Medicare and Medicaid Services (CMS) regulations regarding quality and reimbursement. Place of service affects your reimbursement: Facility, non-facility designations make a difference In 2008, the Office of Inspector General (OIG) for the department of Health and Human Services intends to focus on Place of Service errors for services submitted by physicians. According to the OIG
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