Health Medical Homework Help

HI215: Reimbursement Methodologies

Topic #1: What is the difference between fraud and abuse?

Fraud occurs by individuals to many people that are engaged as a group that work in secret to defraud the organization. When you consider the groups involved in fraud you can see how organized crime has infiltrated the Medicare Program and represented themselves as Medicare providers and suppliers. Health care fraud can also happen at the individual level. Consider the following scenario and answer the discussion prompts below.

Instructions:

While working at the medical office where you are a reimbursement specialist, you notice that a Medicare patient has many more laboratory tests done than a non-Medicare patient.

• Could this be a case of fraud or abuse? Why or why not?
• Is it appropriate to notify your office manager?
• How will you safeguard yourself from getting involved in this type of crime especially if everyone is doing it and it proves highly lucrative?

*Note: This discussion assessed PC-2.3: Demonstrate integrity through the application of relevant codes of conduct and social responsibility within one’s profession.

HI230: Quality Assurance and Statistics in Health Information

Topic #2: What have you learned regarding quality information vs. quality care?
Why is it important for department managers in a hospital to track data of customer needs and productivity? Statistics computed for use within the health information management department usually relate to labor costs, productivity, and staffing, and are often used for decision-making purposes. What types of decisions might they make based on this type of data? Support your thoughts with information from your reading this week or with other research or journal articles.