Assignment: Advanced Reimbursement

Assignment: Advanced Reimbursement

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Course outcome(s) addressed in this Assignment:

HI410-2: Recommend policies and procedures in healthcare reimbursement auditing and monitoring practices.

GEL-8.3: Formulate a logical solution to a problem.

Conduct a browser search to obtain additional information. Enter “Recovery Audit Contractor” in the browser.

Conduct a browser search on government-sponsored programs.

Enter the following in the browser, “Recovery Audit Program > Recent Updates – Centers for Medicare”

Instructions:

Concept to consider:

Imagine that you are a member of the quality assurance staff at a local hospital. You have been asked to provide an update to the medical coders on the current trends pertaining to recovery audit contractor (RAC) issues. This Assignment also examines the National RAC Program and inspector general policies and procedures for monitoring compliance at the local hospital. The summation needs to demonstrate understanding of the RAC policies and present a logical solution for assuring compliance.

Your report needs to include the following:

definition of the problem

analysis of the problem

assessment of potential solutions

a logical solution to the problem

Perform a search on health insurance policies. Prepare a 2–3-page paper (excluding the cover and reference pages) to include the following:

Perform a search on RAC (recovery audit contractor) audits.

Assess the purpose of the RAC audits.

Determine the specific information for your state (depends on which region you are in).

Analyze the kind of information on the amount of money collected (most recent data available).

As a medical coder, explain your role in assuring the accuracy of data and the prevention of an RAC audit. Can it be prevented?

Design a table or graph depicting information you have obtained regarding your state or federal program.

Assess if the RAC has been successful or failing in assuring correct payments.

Conduct a search on the Internet for presenting possible RAC issues.

Demonstrate critical thinking by developing a summation by analyzing the RAC facts.

Viable solution/approach is needed for assuring compliance.

The Medicare/Medicaid and AHIMA websites are good places to start.

Paper must be professionally attractive.

References must be in APA format.

Your submission should:

Create a bibliography citing a minimum of three references according to APA format.

Resources can include your text and chapter references, organizational websites, or such resources as the American Medical Association, American Hospital Association, or the American Health Information Management Association.

The paper should be at least 2–3 pages in length not including any title or reference pages.

The paper should follow the conventions of Standard English (correct grammar, punctuation, etc.).

Your writing should be well ordered, logical, and unified, as well as original and insightful. Your work should display superior content, organization, style, and mechanics.

You should cite sources using APA format.

Paper must be professionally attractive.

Important: Please be sure to visit Academic Tools/Writing Center/Citation Guidelines to assist you with meeting APA expectations for this Assignment.

Assignment: Advanced Reimbursement

Submitting your work:

Put your responses in a Word document. Your table or graph may be copied and pasted into your Word document or may be submitted separately.

Submit your work to the appropriate Dropbox.

Grading Criteria:

Be sure to review the grading rubric for this Assignment.

Unit 3-Assignment 2

Course outcome(s) addressed in this Assignment:

PC3-2: Interact with others in a professional manner using appropriate communication and presentation skills.

Instructions

Imagine you are the health information management director at your local hospital. It has just been announced that the RAC (recovery audit contractor) program is going live in your region in 6 months.

You have been asked to prepare a presentation to the medical staff on the RAC auditing process to help educate the physicians on the process and their role and responsibilities.

In preparation for the development of your presentation, review the information in your text, supplemental reading including the “toolkit,” and available websites for the most up-to-date information.

Your presentation should include, but is not necessarily limited to, the following:

A brief history and overview of the of the recovery audit program.

How the audit is carried out and the different types of auditing processes.

Information pertaining to Medicare Part A–D RAC audits.

The determination and appeal process.

Educational information geared toward physician documentation.

Other steps your department (HIM) and the facility should do to prepare for the recovery audits.

Requirements

The PowerPoint presentation should be between 10–15 slides and address all required elements.

Utilize slide notes as appropriate along with visuals and graphics.

Submit your work to the appropriate Dropbox.

To view your graded work, come back to the Dropbox or go to the Gradebook after your instructor has evaluated it. Make sure that you save a copy of your submitted project.

Your slide presentation should:

Create a bibliography citing a minimum of three references according to APA format.

Resources can include your text and chapter references, organizational websites, or such resources as the American Medical Association, American Hospital Association, or the American Health Information Management Association.

The presentation should be at least 10–15 slides in length not including any title or reference slides.

The presentation should follow the conventions of Standard American English (correct grammar, punctuation, etc.).

Your writing should be well ordered, logical, and unified, as well as original and insightful. Your work should display superior content, organization, style, and mechanics.

You should cite sources using APA format.

Paper must be professionally attractive.

Important: Please be sure to visit Academic Tools/Writing Center/Citation Guidelines to assist you with meeting APA expectations for this Assignment.

Submitting Your Work:

Put your responses in a PowerPoint document. Submit your work to the appropriate Dropbox.

Grading Criteria:

Be sure to review the grading rubric for this Assignment.

Assignment: Advanced Reimbursement

Assignment: Advanced Reimbursement

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.
Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.
LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication

Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.