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Centers for Medicare and Medicaid Services (CMS)

  1. A good financial strategy can always be improved. Having knowledge of your organization’s finances provides the leverage to make decisions that affect the outlook and goals of the company. This assignment gives you an opportunity to examine company practices from a financial lens, which provides you with insight into what drives financial decisions for a health care system.
    Obtain a recent financial statement for your organization, detailing expenses and revenues (This can be from within the last year. You may need to work with your supervisor to obtain a financial statement.).
    Note: If you cannot access a financial statement, discuss it with your faculty member.
    Write a 1,225- 1,550-word report on the major trends in your organization’s expenses and revenues. Include the following points:
    • Analyze any trends in expenses and revenue that you see. Are they on target to meet budget goals? How can your organization contain or reduce expenses without damaging services and quality of care?Can your organization’s reimbursement strategy be improved to increase revenue? If so, what would it be, and how would it be implemented?How can your organization use its financial performance to build its brand?

    Cite any references to support your assignment. 
  • The Centers for Medicare and Medicaid Services (CMS) implemented a new approach to reimbursement starting in 2011 called value-based purchasing. The goal was to reduce the amount of CMS payments overall and to tie patient satisfaction and quality goals to reimbursement. Has this shift in reimbursement strategy been successful? Why or why not? 
  • Health care organizations must opt in to accept payment from Medicare and Medicaid, and payment from private insurance companies usually requires a negotiated contract, with reduced reimbursement rates. What is the reimbursement strategy for your organization? If this information isn’t available to you, research and explain 2 different reimbursement strategies.

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Medicare claims that some large healthcare providers have falsified claims and/or cost reports

Q1:  Medicare claims that some large healthcare providers have falsified claims and/or cost reports. Why, in your opinion do companies tend to overbill services and/or falsify cost reports?  Think of multiple reasons, not just one reason. 

Q2: Discuss fraud and abuse.  Pick two of these initiatives and describe what you know about them or if you’ve had any experience with them.  Why is fraud and abuse important to the federal government in 2012? 

Please provide detailed information and no plagiarism. 

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Medicare spending per beneficiary (MSPB)

Health care organizations such as Choice Hospital must keep up to date with new initiatives related to reimbursement by third-party payers for services provided. This is especially true for Medicare reimbursement and initiatives tied to legislation such as the Affordable Care Act and the 21st Century Cures Act. 

You are working with the chief financial officer and his team on two types of statistics related to Medicare reimbursement initiatives:

  1. Medicare spending per beneficiary (MSPB)
  2. Hospital readmission rates

You will be working with the finance team to prepare a presentation for the CEO and executive leadership team to help them understand these requirements. Your presentation should be 5-7 slides (100-150 words per slide, not including the title and reference slides) with APA formatting. Cite at least 2 scholarly reference articles or government publications that were published within the last 3-5 years.Your presentation should address the following for both the MSPB and hospital readmission rate statistics:

  • Describe the Medicare program or initiative that uses the statistic.
  • Is it an incentive- or penalty-type program related to the rate of Medicare reimbursement?
  • Are the statistics and the program or initiative tied to performance, for example improving quality of care? If so, how?
  • Which legislation is authorizing the Centers for Medicare and Medicaid Services (CMS) to initiate these programs?
  • Define the statistic and how it is calculated.
  • Provide examples of these statistics from publications or government sites. For many of the CMS initiatives, data for health care institutions is made available through the CMS Hospital Compare Web site.

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  • Medicare spending per beneficiary (MSPB)
  •  

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Medicare spending per beneficiary (MSPB)

 Health care organizations such as Choice Hospital must keep up to date with new initiatives related to reimbursement by third-party payers for services provided. This is especially true for Medicare reimbursement and initiatives tied to legislation such as the Affordable Care Act and the 21st Century Cures Act. 

You are working with the chief financial officer and his team on two types of statistics related to Medicare reimbursement initiatives:

  1. Medicare spending per beneficiary (MSPB)
  2. Hospital readmission rates

You will be working with the finance team to prepare a presentation for the CEO and executive leadership team to help them understand these requirements. Your presentation should be 5-7 slides (100-150 words per slide, not including the title and reference slides) with APA formatting. Cite at least 2 scholarly reference articles or government publications that were published within the last 3-5 years.Your presentation should address the following for both the MSPB and hospital readmission rate statistics: