Payment system
Recommendation on transfer cases for the New York State Department of Health
Concerning the issue of transfer cases, I would recommend that the New York department develop and implement Medicaid policies, which would help in restricting and regulating the transfer of inpatient patients between consolidated facilities and or between divisions of emerged facilities. The cases of inappropriate should be checked keenly by the members of the New York State Department of health, especially for the inpatient patient transfer and ensure that there is the recovery of the payments if at all there are wrong payments for the transfer of the patients. Besides, the department management of health in New York State should find the best means of training the health care providers on appropriate billing practices of the hospital services both inside and outside the hospital during the transfer of the patient. According to Chalasani & Koritala (2019), training can be done ones in a month through conferences and seminars conducted by educators who are highly knowledgeable on issues of hospital financing and patient transfer. The evaluation of the billing practices should be done monthly, too, within the hospital. Don't use plagiarised sources.Get your custom essay just from $11/page
Main differences in the calculation of Transfer Cases
The main differences exhibited in the calculations after reviewing the exhibits in 7-3 and 7-4 are the Work GPCI, Malpractice expense GPCI and the Expense GPIC.
Type of payment system during the determination of payment prior to the delivery of the service needed
The amount of payment is decided upon way before the delivery of the required services in the prospective payment system (PPS) reimbursement method.
Utilization control that is highly associated with managed fee-for-service reimbursement
One of the utilization control that is highly related to the managed fee-for-service reimbursement in the retrospective utilization review.
Concept of capitation
Capitation is the fixed amount of the remittances that are delivered per patient and according to the unit of the time used in the delivery of health care services in which the physician receives the money before the delivery of the health care services (Chalasani & Koritala, 2019). Several factors determine the amount of money in which the physician will be paid. Among the factors to be considered are the number of health services to be offered to the patient. The number of patients who will be attended to by the physician within that scheduled time and the duration in which the health care services will be delivered to the patients in need of the specific health care services.
Medicare Part A payments on the basis of prior implementation of the diagnosis-related group PPS
The Medicare Part A payments that were done to the health facilities before the implementation of the diagnosis-related group PPS highly depended on the cost of the health care services being offered by the health institution and were always called retrospective reimbursements or Cost-plus Reimbursements.
Basis of the MS-DRG prospective payment rates
The basis of the MS-DRG prospective payment rates was done with respect to the type of diagnosis called the inpatient prospective payment system, which is commonly known as the PPS.
Significant differences that determined the qualifications for outlier payments
The determination of the eligibility for the outlier payment was based on the total costs (Desai et al., 2016). Therefore, in a situation where the total costs were way above the combined threshold, the outlier payments were made, but in a case where the total costs were below the combined threshold, then the payments were restricted and not paid.
Coinsurance and copayment amount
In the case of Mr. Smith, he is supposed to pay coinsurance. On the other hand, Mr. Jones is supposed to pay a copayment. Lastly, Mrs. Day is supposed to pay for the copayment too.
References
Chalasani, S., & Koritala, S. (2019). An Integrated Case to Teach Healthcare Reimbursement. Business Education Innovation Journal, 11(1).
Desai, T., Ali, S., Fang, X., Thompson, W., Jawa, P., & Vachharajani, T. (2016). Equal work for unequal pay: the gender reimbursement gap for healthcare providers in the United States. The postgraduate medical journal, 92(1092), 571-575.
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