Legal and Regulatory Issues – The 1986 Health Care Quality

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Review the following lecture:

Legal and Regulatory Issues

Introduction:

The 1986 Health Care Quality Improvement Act established a database that is intended to improve the quality of healthcare in this country. Two other databases have merged with it and now offer many potential advantages.

Tasks:

  • Describe the National Practitioner Data Bank (NPDB).
  • Identify the uses of the NPDB.
  • Analyze any limitations of the NPDB.
  • Describe how NPDB relates to billing for services.

Claims management is the art of consolidating, billing

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Claims management is the art of consolidating, billing, filing, revising, and managing medical claims, an imperative aspect of the healthcare industry. Medical facilities cannot receive due funds if patients are unaware of how much they need to pay. Ensuring provider organizations understand the fundamentals of medical billing and coding can help providers and other staff operate a smooth revenue cycle.

Tasks:

  • Explain some of the common medical billing and coding challenges/issues.
  • Explain the impact of improper claims management.
  • Describe how technology can be helpful when it comes to medical billing and what tools are available.

Medicare and Medicaid are federal programs

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Medicare And Medicaid

Introduction:

Medicare and Medicaid are federal programs that cover a large proportion of the US population with healthcare. The two have similar objectives in the area of providing care, but there are significant differences in them that concern reimbursement.

Tasks:

  • Describe each program, Medicare and Medicaid.
  • Provide the major features of each program.
  • Discuss how these programs differ from each other.
  • Briefly describe the process of how to bill for each program.

Effective management is crucial for any leader/manager

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Effective Management

Effective management is crucial for any leader/manager.

Identify the leadership factors most important to group morale and discuss the links between morale and performance. How might this affect political appointees who may not know the organizational processes and/or culture of their agency? Include at least one source which can be your textbook.  

This week we reviewed chief executives and the challenges of administrative leadership. Find a contemporary news story about a prominent public official who faced leadership challenges and was ousted from office. Suggested sites on which to find credible news include The New York Times, The Wall Street Journal, CNN, or NPR, just to name a few. Provide a summary of the situation, using concepts described in this week’s chapter.  What were the factors that lead to the official’s downfall? Be sure to include a link or attachment of your news piece and cite your source. 

Discussion – Research the company you have

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 Discussion Post

Research the company you have chosen for your final project and do your best to determine the current structure of the company (centralized or decentralized). Share current resource (less than 8 weeks old) and examples to support why you chose centralized or decentralized. If you were leading the company, would you leave the structure as-is? Why or why not?