Unit VIII PowerPoint Presentation
Instructions
For the Unit VIII PowerPoint Presentation, you will assume the role of a candidate interviewing for the director of medical billing at Columbia Southern Medical Group. The interview panel has provided you with five questions, and they would like you to create presentation slides with your response(s). Below are the five interview questions.
- Columbia Southern Medical Group is an organization that prides itself on being on the forefront of innovation. By fulfilling this role as the director of medical billing, you would be expected to maintain knowledge on health insurance developments and new strategies in the field. What three recent developments in health care have influenced the climate of reimbursement the most, in your opinion? Be sure to detail each development. (two slides)
- Some of your tasks as director of medical billing will lead you to be involved in Columbia Southern Medical Group’s medical coding procedures. Seeing that Columbia Southern Medical Group provides both inpatient and outpatient services, explain the types of medical coding that will be used in your department. Explain the relationship between the coding and billing departments and identify some of the issues that could arise with incorrect coding/billing. (two slides)
- Columbia Southern Medical Group does accept Medicare assignment in most cases, but there are two facilities owned by Columbia Southern Medical Group that do not participate with the Medicare program. With what you know about the Medicare Physician Fee Schedule (MPFS) and how it differs regarding participating providers versus non-participating providers, outline the differences in how these separate entities would conduct payments with this system. It may be a good idea to provide an example with the two different calculations describing how a service or procedure would be reimbursed under these scenarios. (two slides)
- Being in compliance with health care regulations is of the utmost importance to Columbia Southern Medical Group, and it is imperative that all of its departments operate ethically and with integrity. One of your tasks as director will be to implement policies that will provide protection and security of all sensitive data housed in your department. Name safeguarding techniques that you will use to ensure privacy and security of patient information. Furthermore, describe regulatory standards and/or health care laws that will explain and enforce compliance measures. How do these measures help combat fraud and abuse? (two slides)
- Columbia Southern Medical Group has always worked hard to create an atmosphere of continuous improvement as that has shown to lead to a more quality experience for the patient. By keeping up with current trends in the industry as well as ensuring that all regulatory and legal requirements are met, Columbia Southern Medical Group will continue to provide quality unmatched by others. One regulatory requirement that you will be tasked with as the director of medical billing is auditing. What are some health care third-party audits specific to medical billing and coding of which you will need to be knowledgeable? What are your thoughts on random self-audits? Do you think they can be helpful to you and your department if you were to obtain this position? (two slides)
Your presentation should consist of a total of 10 slides, not counting the title and reference slides.
Access PowerPoint Basics for a helpful resource that will provide you with some guidance in creating a professional presentation. The transcript for this resource can be found within the “Notes” tab to the right of the presentation
Expert Solution Preview
Introduction: As the director of medical billing at Columbia Southern Medical Group, it is important to have a thorough understanding of the ever-evolving healthcare industry. In this PowerPoint presentation, the focus will be on addressing the five interview questions provided by the interview panel.
1. Three recent developments in healthcare that have influenced the climate of reimbursement are the shift towards value-based care, price transparency initiatives, and the use of technology to monitor and track patient outcomes. Value-based care emphasizes quality over quantity of services provided and rewards healthcare providers for delivering better patient outcomes. Price transparency initiatives aim to make healthcare pricing information more accessible to patients, enabling them to make more informed decisions about their healthcare. The use of technology, such as telemedicine and electronic health records, has streamlined the healthcare process and enabled healthcare providers to better track and monitor patient outcomes.
2. Medical coding is a critical function of the billing department, and there are two types of medical coding: ICD-10-CM and CPT. ICD-10-CM codes are used to identify diagnoses, while CPT codes are used to identify procedures and services. The coding and billing departments are closely linked, as accurate coding is necessary for proper billing. The main issues that could arise with incorrect coding or billing include denied claims, delayed payments, and compliance issues.
3. The Medicare Physician Fee Schedule (MPFS) differs for participating providers versus non-participating providers. Providers who participate in the Medicare program are reimbursed at 95% of the MPFS rate, while non-participating providers are reimbursed at 75% of the MPFS rate. For example, if a service or procedure has an MPFS rate of $100, participating providers would be reimbursed $95, while non-participating providers would be reimbursed $75. This highlights the importance of participating in the Medicare program for facilities owned by Columbia Southern Medical Group.
4. To ensure privacy and security of patient information, safeguarding techniques such as access controls, audit logs, and encryption will be implemented. Regulatory standards and healthcare laws, such as HIPAA and HITECH, enforce compliance measures to protect patient information from fraud and abuse. These measures help to maintain the integrity of data and ensure that patient privacy is protected.
5. Health care third-party audits specific to medical billing and coding include Recovery Audit Contractor (RAC) audits and Medicare Administrative Contractor (MAC) audits. Random self-audits can be helpful to identify potential problems and ensure compliance, but they should not replace a thorough and systematic auditing process. The use of both types of audits can ensure that policies and procedures are being followed correctly and avoid any potential issues with non-compliance.
