HSM 420 Legal Issues in Provider Contracting

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HSM 420 Legal Issues in Provider Contracting
Describe and discuss the key issues associated with provider payment that should be addressed in any managed…

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HSM 420 Legal Issues in Provider Contracting

HSM 420 Legal Issues in Provider Contracting

Discussions Week 2 All Students Posts 32 Pages

Describe and discuss the key issues associated with provider payment that should be addressed in any managed care contract.  The way that providers are reimbursed has been simplified.  Why are some providers having issues with receiving payment?…

This form of reimbursement seems to be simple enough.  However, how are services administered outside of the bundle requirements paid?  Are providers allowed to bill additional services?  Over billing/fraudulent billing is one of the major contributors to our healthcare deficit.

What more can be done to prevent such acts?  What is the grace period for errors?  Are providers being penalized for these errors?  Can you tell us what prompted the implementation of the ICD-10 codes?  Do you think that we should revert back to more of an indemnity environment?  Should we allow providers to determine pricing?  What are some examples of medical records being compromised?  What are the consequences?  What are more incentives that can be offered to encourage individuals to seek preventative care?…