HI 215 Purdue University Global Payment and Reimbursement Process Case Study

Instructions

  1. Case Study: Case Study 7: Transfer Case. Write a 2–3 paragraph response discussing what would you recommend that the New York State Department of Health do to address the payment issue with transfer cases? List at least three recommendations along with your rationale.
  2. Refer to your reading from the PG Library this unit (Chapter 16: “Reimbursement Methodologies” (from the section headed “Healthcare Reimbursement Methodologies” to “Resource-Based Relative Value Scale System”) and answer the following questions in one to two complete sentences:
    1. What type of payment system is in place when the amount of payment is determined before the service is delivered?
    2. Which utilization control is most closely associated with managed fee-for-service reimbursement?
    3. Describe the concept of capitation.
    4. What were Medicare Part A payments to hospitals based on prior to implementation of the diagnosis-related group PPS?
    5. What type of diagnosis is the MS-DRG prospective payment rate based on?

Assignment Requirements

  • Please complete all parts in a Microsoft Word document.
  • Quoting should be less than 10% of the entire paper. Paraphrasing is necessary.
  • You must cite and reference credible sources.
  • Utilize the Academic Success Center in Academic Tools for assistance with writing, APA style references, etc.
  • I have attached the case study and rubric to help complete assignment

Expert Solution Preview

Introduction:
The role of a medical professor entails designing assignments, conducting lectures, and evaluating student performance. In this assignment, we will be discussing a case study on transfer cases and payment issues and answering questions from the reading on reimbursement methodologies.

Answer 1:
To address the payment issue with transfer cases, the New York State Department of Health can implement the following recommendations: first, increase the Medicaid reimbursement rate for transfer cases to cover the actual cost of the service. Second, create a separate reimbursement category for transfer cases to ensure that the hospitals receive appropriate payment. Third, establish a committee to monitor the transfer process and ensure that hospitals comply with the regulations. These recommendations will ensure that the hospitals are adequately compensated for the care provided to patients who require transfer.

Answer 2:
a) A prospective payment system is in place when the amount of payment is determined before the service is delivered.

b) Utilization review is most closely associated with managed fee-for-service reimbursement.

c) Capitation is a payment methodology where healthcare providers receive a fixed fee per patient per unit of time, regardless of the services provided.

d) Medicare Part A payments to hospitals were based on the reasonable cost incurred in providing services to patients before the implementation of the diagnosis-related group PPS.

e) The MS-DRG prospective payment rate is based on the patient’s diagnosis and the resources required to treat the condition.

Share This Post

Email
WhatsApp
Facebook
Twitter
LinkedIn
Pinterest
Reddit

Order a Similar Paper and get 15% Discount on your First Order

Related Questions

DescriptionCollege of Administration and Finance Sciences Form No 4- Internship Report Cover Page Student`s name: Student`s ID #: Training

Description College of Administration and Finance Sciences Form No 4- Internship Report Cover Page Student`s name: Student`s ID #: Training Organization: Trainee Department: Field Instructor Name: Field Instructor Signature: Course Title: CRN: Internship Start Date: Internship End Date: Academic Year/Semester: For Instructor’s Use only Instructor’s Name: Total Training Hours /280

DescriptionAbdulmajed Mentorship plays a crucial role in the personal and professional development of healthcare caregivers, contributing to

Description Abdulmajed Mentorship plays a crucial role in the personal and professional development of healthcare caregivers, contributing to enhanced clinical skills, emotional well-being, confidence, and job satisfaction. By providing guidance, support, and opportunities for growth, mentorship facilitates the transfer of knowledge, experience, and best practices from experienced professionals to their

SLP/BUS530 Managerial Economics  Economic Justice and Organizational Strategy Assignment Overview Presentation On an economic topic that has staunch

SLP/BUS530 Managerial Economics  Economic Justice and Organizational Strategy Assignment Overview Presentation On an economic topic that has staunch supporters on multiple perspectives. SLP Assignment Presentation: Economics of Social Responsibility and Profit  Social Responsibility and Profit must be balanced and consider at least two different viewpoints. The main focus must be

DescriptionSAAD ALSITAMI M 14 COLLAPSE Mentorship is crucial in the personal and professional development of healthcare caregivers, playing a

Description SAAD ALSITAMI M 14 COLLAPSE Mentorship is crucial in the personal and professional development of healthcare caregivers, playing a significant role in enhancing clinical skills, emotional well-being, confidence, and job satisfaction. Below are specific examples of how mentorship contributes positively to healthcare professionals and the broader healthcare environment. Enhancement

Case/BUS530 Managerial Economics  Economic Justice And Organizational Strategy Assignment Overview Economic Justice Economic Justice is a global issue. The

Case/BUS530 Managerial Economics  Economic Justice And Organizational Strategy Assignment Overview Economic Justice Economic Justice is a global issue. The struggle for Economic Justice in modern America is not a new movement. Paradigm-shifting events in 2020 pushed companies and organizations to address inequities and assess their track records while devising a