Please prepare a half page response for each part: Part 1, The mere fact the Medicare billing guidelines have over three hundred pages, it is indication of the complexity of the process overall. After reviewing the guidelines and the level of detail to which they have actually been written, I am of the opinion they do not serve a good purpose.

Please prepare a half page response for each part:

Part 1,

The mere fact the Medicare billing guidelines have over three hundred pages, it is indication of the complexity of the process overall. After reviewing the guidelines and the level of detail to which they have actually been written, I am of the opinion they do not serve a good purpose.

 

Paper instructions:
Please prepare a half page response for each part:

Part 1,

The mere fact the Medicare billing guidelines have

over three hundred pages, it is indication of the

complexity of the process overall. After reviewing the

guidelines and the level of detail to which they have

actually been written, I am of the opinion they do not

serve a good purpose. While it is understood there

needs to be guidelines that will regulate reimbursement

rates based on services delivered and their geographic

areas, the paper billing process is complex,

cumbersome and gives opportunity to the fraudulent

activity that has been seen for many years.

A review of the claims processed by Medicare from

2001 to 2010 yield the following key findings: 1)

healthcare professionals have steadily billed Medicare

higher rates resulting in $11 billion dollars of inflated

charges, 2) up-coding or charging for more complex

services than those delivered, 3) much of the increase

of higher billing practices seems to happen in hospital

emergency rooms, and 4) an increase in the abuse of

billing for costly services seems to be on the rise due to

lax oversight and the transitioning to electronic records

which can actually contribute to the billing abuse

(Schulte and Donald, 2012). With the reimbursement

rates from Medicare for physician services not keeping

pace with the rising costs of inflation which physician

offices are faced with, it has left them no alternative but

to find creative ways to make ends meet. While CMS

feels most physicians and hospitals are honest in their

billing practices, it has left room for the occasional

overbilling which is costing taxpayers millions of dollars

on a yearly basis. It is understandable that costs for

medical services will vary based on geographic area,

however in order for the system to work it is also

necessary for the system to take into account the

economic factors, such as inflation that impact the

healthcare providers when establishing the

reimbursement rates.

Part 2

I do not believe Medicare billing guidelines are

served well. Medicare is the federal health insurance

program for the elderly and disabled. There are two

major Medicare programs-Part A and Part B. Part A

covers some areas such as hospitalization, hospice,

skilled nursing facilities, and some home health services.

Part B covers some areas such as physician services,

outpatient hospital services, laboratory charges,

medical equipment, and other home health services.

The federal government spent a lot on Medicare

services in the past years. According to the data from

Social Security Administration, the budget on Medicare

services increased from $57.9 billion to $271 billion in

2003 (Levinson, 2013). In order to reduce costs and

prevent fraud, the government created a complex

regulatory structure for Medicare billing and

reimbursement. The Medicare billing guidelines are

complex and vague in some areas, such as elective

surgeries, initial services, and collaboration. In terms of

initial services, the advanced practice registered nurse

(APRN) may or may not be able to charge

independently for a patient with a chronic medical

condition but a new complaint, say a diabetic patient

who now has difficulty breathing, depending on

whether “initial service” reflects the initial visit for

diabetes management or the initial visit for the new

complaint of dyspnea. The governments should clarify

the standard for initial service.

Medicare Part A provides inpatient hospital

insurance benefits and coverage of extended care

services for beneficiaries after they are discharged from

hospitals. Medicare requires that certain elective

surgeries be performed in an inpatient hospital setting.

According to research by Dainel Levinson, in the

calendar years 2009 and 2010, Medicare made Part A

prospective payments to hospitals of $597 million for

inpatient claims that involved a canceled elective

surgery. Almost $55 million involved short-stay (2 days

or fewer) claims (Levinson, 2013). When an inpatient

hospital admission is based on the expectation that a

patient will have elective surgery but that surgery does

not occur, that cancellation would generally make the

admission not reasonable and necessary. The

government should revise the admission policy for

elective surgeries to reduce claims for patients who did

not have surgery in a hospital.

WHY SHOULD YOU HIRE EXPERT ACADEMIC WRITERS?

Answering this question is not essay as it seems. It will require you to research or burn your brain power, write your findings down, edit, proofread severally, and submit unsure of the grade you will get. Essay96.com assignment writers are offering to take care of that. Order your assignment now, relax, submit, and enjoy excellent grades. We guarantee you 100% original answers, timely delivery, and some free products.

>>ORDER NOW<<

>>SEE TOP WRITERS<<

Posted in Uncategorized