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.

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