Describe one of the types of ACOs available to providers. Why is it so important to accurately code diagnoses and procedures as this relates to the ACOs?
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- The Centers for Medicare & Medicaid Services (CMS) is responsible for Accountable Care Organizations (ACOs). Describe one of the types of ACOs available to providers.
- Why is it so important to accurately code diagnoses and procedures as this relates to the ACOs?
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- The Centers for Medicare & Medicaid Services (CMS) is responsible for Accountable Care Organizations (ACOs). Describe one of the types of ACOs available to providers. Reply to at least two (2) classmates, with a minimum of 75 words each post. Why is it so important to accurately code diagnoses and procedures as this relates to the ACOs?Clinical Documentation Guidelines may be set by various licensing and regulatory agencies, as well as provided as guidelines by professional associations. For the purpose of this discussion, compare and contrast guidelines provided by CMS, NCQA, and AHIMA. You may use the links below for your convenience: CMS: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/CERTMedRecDoc-FactSheet-ICN909160.pdfLinks to an external site. NCQA: https://www.ncqa.org/wp-content/uploads/2018/07/20180110_Guidelines_Medical_Record_Documentation.pdf Links to an external site. AHIMA: Read documentation guidelines in Fahrenholz, Chapter 2https://campus.ahima.org/campus/courses/CB/course_docs/HDCS/HDCS_V3_C2_FunctionsHealthRecord.pdfThe Physician Self-Referral Law, also known as the “Stark Law,” generally prohibits a physician from making referrals to an entity for certain healthcare services, if the physician has a financial relationship with the entity. How can a physician get around the Physician Self-Referral Law?
- You attended an in-service education program about the outpatient prospective payment system (OPPS) where you learned that certain Medicare Part B services are paid according to ambulatory payment classifications (APCS), which group services according to similar clinical characteristics and in terms of resources required. A payment rate is established for each APC and, depending on services provided, hospitals may be paid for more than one APC for a patient encounter. As part of the in-service, you are provided with the following information and required to answer each question by applying the formula to calculate APC payments. Outpatient Prospective Payment System (OPPS) Formula (APC Weight x Conversion Factor x Wage Index) + Add-On Payments = Payment NOTE: When a patient undergoes multiple procedures and services on the same day, multiple APCS are generated and payments are added together. APC software automatically discounts multiple APC payments when appropriate (e.g., bilateral…You attended an in-service education program about the outpatient prospective payment system (OPPS) where you learned that certain Medicare Part B services are paid according to ambulatory payment classifications (APCS), which group services according to similar clinical characteristics and in terms of resources required. A payment rate is established for each APC and, depending on services provided, hospitals may be paid for more than one APC for a patient encounter. As part of the in-service, you are provided with the following information and required to answer each question by applying the formula to calculate APC payments. Outpatient Prospective Payment System (OPPS) Formula (APC Weight x Conversion Factor x Wage Index) + Add-On Payments = Payment NOTE: When a patient undergoes multiple procedures and services on the same day, multiple APCS are generated and payments are added together. APC software automatically discounts multiple APC payments when appropriate (e.g., bilateral…Medicare and other payers may consider a procedure to be non covered service when performed in an ASC for several reasons. List two detail answer please typed
- Medicare ACOs and bundled payment programs/strategies rely on the use which of the following organizational structures: Question options: 1) Vertical Integration 2) Horizontal Integration 3) Physician Alignment 4) Vertical Integration and Physician Alignment 5) Horizontal Integration and Physician AlignmentWhich of the following refers to a real time system that allows patients to access their medical records, medication lists, and referrals, in addition to providing the ability to communicate directly with providers and schedule appointments? A Telemedicine B Electronic medical record C Telehealth D Patient portalList and discuss the risks to a healthcare organization in failing to allocate sufficient support and resources to a newly implemented healthcare information system or EMR.
- Which step of medical billing process is the most important? Why?In the late 20th century, many methods were used to pay physicians for services rendered. The most popular methods include all the following except payment as a base salary. according to a schedule of fee-for-service (FFS). based on usual, customary, reasonable (UCR) charges. based on resource based relative values(RBRVs). based on patient outcomes.The federal Medicare program will only reimburse (pay) for services performed by health professionals who are licensed to practice and certified to participate in the Medicare program. Let's say someone files a lawsuit arguing that this federal law allowing only licensed and certified health professionals to be paid through the Medicare program discriminates against people who don't have medical training, and therefore violates the Equal Protection Clause of the 5th Amendment? Which of the following best explains how a court would rule in such a case?
