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What reasons could account for the gap between the reimbursement for multidisciplinary care and the expenses of delivery of multidisciplinary care?

In evaluating the RBRVS reimbursements for the physician practice, what other data should the intern consider? The intern notes that code 99205 has the highest RVU. Explain whether the intern should advise the practice to recruit more very sick new patients (office visit, new patient, high complexity).

Describe the elements of the outpatient and inpatient prospective payment system.

Why does the IPF PPS length-of-stay adjustment factor grow smaller during the patient encounter?

Describe at least two of the patient-level adjustments for IPF PPS claims and why they are used.

Envision governmental involvement and incentive initiatives for providing cost effective healthcare.

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11/1/2020 Unit 7 Assignment – HI410 Advanced Reimbursement Methodology https://purdueglobal.brightspace.com/d2l/le/content/143224/viewContent/10715241/V iew 1/7 Unit 7 A ssig n m en t Cours e o utc o m e(s ) a d dre ssed in t h is A ssig nm en t: H I4 10-4 : D ete rm in e a ppro pria te c a lc u la tio ns u se d fo r u tiliz a tio n m anagem ent a n In str u ctio ns: C oncep t t o C onsid er: Im agin e y o u a re th e m edic a l c o der a t y o ur lo ca l h osp it a l. It h as ju st b een a nnoun A ccre dit a tio n o f H ealt h ca re O rg aniz a tio ns (J C AH O ) is g oin g to e va lu ate th e a m b re im burs e m ent s yste m s. Y ou h ave b een a ske d to p re pare a p re se nta tio n to th e a ccre dit a tio n c o m mit te e a th e h ealt h ca re p ro vid ers a bout th e r e im burs e m ent r a te s. In p re para tio n fo r th e d in fo rm atio n in y o ur te xt, s u pple m en ta l r e adin g in clu din g th e “ to olk it ,” a nd a va ila b in fo rm atio n. P erfo rm a s e arc h o n h ealt h in su ra nce p olic ie s a nd r e vie w th e te xtb ook to a nsw e Pre pare 2 –3 p ara gra phs fo r e ach q uestio n. T he p aper s h ould in clu de th e fo ll o w i D ocu m en t: T hir d p arty p aye rs h ave a dopte d M edic a re ’s r e so urc e -b ase d r e la tiv e v a lu e s ca le t h e R BR VS h as b een s u ggeste d a s a w ay to a naly ze p ro ductiv it y a nd h ealt h ca re a l. 2 004; R ota riu s a nd L ib erm an 2 00 1). A le xa ndra ki a nd c o lle agues u se d th e R BR VS to a naly ze a nd c o m pare th e p ro du a nd a h osp it a lis t- b ase d s e rv ic e ( A le xa ndra ki e t a l. 2 009, 8 1). A r e sid ent- s ta ff e d te ach in g s e rv ic e u se s r e sid ents to m anage th e c a re o f p atie nts . m edic a l s ch ool a nd in te rn sh ip a nd a re n ow r e ce iv in g a dva nce d tr a in in g in a s p ec d erm ato lo gy, o r p edia tr ic s. A h osp it a lis t- b ase d s e rv ic e u se s h osp it a lis ts to m ana p hysic ia n who sp ecia liz e s in managin g th e ca re ofh osp it a lin patie nts A ssig nm en t D eta ils H I4 1 0 A dvan ce d R eim burs e m en t M eth o do lo gy C B 11/1/2020 Unit 7 Assignment – HI410 Advanced Reimbursement Methodology https://purdueglobal.brightspace.com/d2l/le/content/143224/viewContent/10715241/V iew 2/7 physic ia n w ho s p ecia liz e s in m anagin g th e c a re o f h osp it a l in patie nts . A cco rd in g to th e s tu die s th at A le xa n dra ki a nd c o lle agues r e vie w ed, th e tw o s e rv S im ila r in te rm s o f q ualit y o f c a re , s u ch a s m orta lit y r a te s, n oso co m ia l in fe cti h osp it a l D if f e re nt in te rm s o f a dm in is tr a tiv e m easu re s w it h h osp it a lis t- b ase d s e rv ic e s h osp it a l e xp ense s ( A le xa ndra ki e t a l. 2 009, 8 1). H ow eve r, A le xa ndra ki a nd h er c o lle agues n ote d th at th ere w as th e la ck o f r e se a th e tw o s e rv ic e s ( A le xa ndra ki e t a l. 2 009, 8 1). T o b egin to a ddre ss th is d efic it , th p ro ductiv it y u sin g th e r e la tiv e v a lu e u nit ( R VU ) o f th e R BR VS a s th e in dic a to r o f K ey d ata in th eir in ve stig atio n w ere R VU s fo r r e le va nt C PT c o des C harg es fr o m p ra ctic e b illin g r e co rd s To ta l R VU s g enera te d p er u nit o f e nco unte r ( in it ia l a nd s u bse quent h osp it a l v T o ta l R VU s g enera te d p er c lin ic a l fu ll- tim e e quiv a le nt ( F TE ) ( re sid ent o r h osp L ength o f s ta y C ase -m ix in dex D ata w ere c o lle cte d o n 5 ,9 43 p atie nts d is ch arg ed d urin g th e p erio d o f th e s tu dy P atie nts a dm it te d to in te nsiv e c a re u nit s o r c o ro nary c a re u nit s w ere e xclu ded fr o v a ria bilit y in th e in te nsit y o f s e rv ic e s p ro vid ed to th ese p atie nts . T he r e se arc h ers g enera te d p er p ro vid er w ere s ig nif ic a ntly h ig her fo r th e r e sid ent- s ta ff e d te ach in g T he r e se arc h ers c o nclu ded th at th e d if f e re nce c o uld b e r e la te d to th e lo w er tim e th an h osp it a lis ts ( A le xa ndra ki e t a l. 2 009, 8 4). F in ally , th e r e se arc h ers o bse rv e th a t th e R BR VS is a s ta ndard iz e d to ol. It c a n b e d if f e re nt e nvir o nm ents in te rm s o f h ealt h ca re o rg aniz a tio n, g eogra phic r e gio n, o r 8 4). R ese arc h ers a ls o e xa m in ed w heth e r th e R BR VS p aym ent m eth od s u ff ic ie ntly c o te am tr e atin g p edia tr ic a m bula to ry d ia bete s p atie nts in a p edia tr ic e ndocrin olo gy re se arc h ers e xp la in ed th at a m bula to ry p edia tr ic c a re fo r d ia bete s m ell it u s h as e v T he te am c o m pris e s p edia tr ic e ndocrin olo gis ts , c e rtif ie d d ia bete s m ell it u s n urs e so cia l w ork e rs , a nd p sych olo gis ts . T he c lin ic r e ce iv e s o ne p aym ent b ase d o n th e To s tu dy th e a dequacy o f th e r e im burs e m ent fo r m ult id is cip lin ary c a re , b illin g d at th e p erio d J u ly 1 , 2 003 th ro ugh J u ne 3 0, 2 004 w ere r e vie w ed. T he r e se arc h ers f v is it s w ere fo r c a re o f d ia bete s m ellit u s. T he c lin ic fo llo w ed th e r e co m mendatio n 11/1/2020 Unit 7 Assignment – HI410 Advanced Reimbursement Methodology https://purdueglobal.brightspace.com/d2l/le/content/143224/viewContent/10715241/V iew 3/7 optim al c a se m anagem ent. T hese r e co m mendatio ns in clu de p atie nt a nd fa m il y e d ie t, e xe rc is e , a nd lo ng-te rm m onit o rin g. T he r e se arc h ers n ote d th at th e te le pho p artic u la rly e xp ensiv e , a lt h ough a n im porta nt c o m ponent o f c a re . T he r e se arc h ers c a lc u la te d r e ve nue u sin g th e R BR VS m eth od. T hey fo und th at m eth od w ere s u ff ic ie nt fo r th e p hysic ia ns’ e xp ense s in th e te am a ppro ach . H ow e genera te d u nder th e R BR VS m eth od o nly c o ve re d 1 6 p erc e nt o f th e a ctu al n onp m ult id is cip lin ary m odel. T hus, th e r e im burs e m ent d oes n ot a dequate ly r e im burs e p ra ctic e e xp ense s. T he r e se arc h ers c o nclu ded th at th e m ult id is cip lin ary c a re m o Rota riu s a nd L ib erm an c o nclu ded th at a naly sis u sin g th e R BR VS p ro vid es v a lu a in clu de: F ulf illm ent o f c o ntr a ctu al p aym ent r a te s b y h ealt h ca re in su ra nce p la ns P ro fit a bilit y o f s p ecif ic p ro ce dure s O ptim al m ix o f p hysic ia n s p ecia lt ie s P ro je ctio ns fo r c o ntr a ct n egotia tio n s T here fo re , a naly sis u sin g th e R BR VS is a m eans o f p ro ductiv it y a sse ssm ent, fin A s tu dent in a h ealt h s e rv ic e s m anagem ent ( H SM ) a ca dem ic p ro gra m w as s e rv i stu dent h ad r e ad th e p re vio us a rtic le s a bout th e p ote ntia l fo r in su ff ic ie nt r e im burs T he H SM in te rn d ecid ed to a naly ze th e fin ancia l v ia bilit y o f th e p ra ctic e . T he in te A NY Y EA R: P ro je cte d R even ue b y C PT ® V is it C ode* W ork R VU N on- Fac P E R VU M P RVU To t R VU (C ol B + C ol C + C ol D ) Co It e m $ 99202-O ff ic e V is it , N ew , Str a ig htfo rw ard 0 .8 8 0.7 9 0.0 5 1.7 2 11/1/2020 Unit 7 Assignment – HI410 Advanced Reimbursement Methodology https://purdueglobal.brightspace.com/d2l/le/content/143224/viewContent/10715241/V iew 4/7 Str a ig htfo rw ard M edic a l D ecis io n M akin g 99203-O ff ic e V is it , N ew , L ow C om ple xit y M edic a l D ecis io n M akin g 1.3 4 1.1 3 0.0 9 2.5 6 9 9204-O ff ic e V is it , N ew , M odera te C om ple xit y M edic a l D ecis io n M akin g 2.0 0 1.5 0 0.1 2 3.6 2 9 9205-O ff ic e V is it , N ew , H ig h C om ple xit y M edic a l D ecis io n M akin g 2.6 7 1.7 8 0.1 5 4.6 0 9 9211 -O ff ic e V is it , E st., M ay N ot R equir e P re se nce o f P hysic ia n 0.1 7 0.3 9 0.0 1 0.5 7 11/1/2020 Unit 7 Assignment – HI410 Advanced Reimbursement Methodology https://purdueglobal.brightspace.com/d2l/le/content/143224/viewContent/10715241/V iew 5/7 99212-O ff ic e V is it , E st., S tr a ig htfo rw ard M edic a l D ecis io n M akin g 0.4 5 0.5 4 0.0 3 1.0 2 9 9213-O ff ic e V is it , E st., L ow C om ple xit y M edic a l D ecis io n M akin g 0.6 7 0.6 9 0.0 3 1.3 9 9 9214-O ff ic e V is it , E st., M odera te C om ple xit y M edic a l D ecis io n M akin g 1.1 0 1.0 3 0.0 5 2.1 8 9 9215-O ff ic e V is it , E st., H ig h C om ple xit y M edic a l D ecis io n M akin g 1.7 7 1.3 2 0.0 8 3.1 7 11/1/2020 Unit 7 Assignment – HI410 Advanced Reimbursement Methodology https://purdueglobal.brightspace.com/d2l/le/content/143224/viewContent/10715241/V iew 6/7 A ll P hysic ia ns’ C urre nt P ro ce dura l T e rm in olo gy® ( C PT® ) fiv e -d ig it n um eric c o de in str u ctio ns, g uid elin es, a nd o th er m ate ria ls a re c o pyrig hte d b y th e A m eric a n M e * V alu es a re r e pre se nta tiv e o nly ; r e aders a re c a utio ned to c h eck c u rre nt F edera Q uestio ns P re p are 2 –3 p ara g ra p hs f o r e ach q uestio n: 1. W hat r e aso ns c o uld a cco unt fo r th e g ap b etw een th e r e im burs e m ent fo r m ult id m ult id is cip lin ary c a re ? 2. In e va lu atin g th e R BR VS r e im burs e m ents fo r th e p hysic ia n p ra ctic e , w hat o th e n ote s th at c o de 9 9205 h as th e h ig hest R VU . E xp la in w heth er th e in te rn s h ould p atie nts ( o ff ic e v is it , n ew p atie nt, h ig h c o m ple xit y ). 3. D escrib e th e e le m ents o f th e o utp atie nt a nd in patie nt p ro sp ectiv e p aym ent s ys 4. W hy d oes th e IP F P PS le ngth -o f- s ta y a dju stm ent fa cto r g ro w s m alle r d urin g th 5. D escrib e a t le ast tw o o f th e p atie nt- le ve l a dju stm ents fo r IP F P PS c la im s a nd w 6. E nvis io n g ove rn m enta l in vo lv e m ent a nd in ce ntiv e in it ia tiv e s fo r p ro vid in g c o st Y o ur s u bm is sio n s h ould : 1. C re ate a b ib lio gra phy c it in g a m in im um o f th re e r e fe re nce s a cco rd in g to A PA f 2. R eso urc e s c a n in clu de y o ur te xt a nd c h apte r r e fe re nce s, o rg aniz a tio nal w ebsi A sso cia tio n, A m eric a n H osp it a l A sso cia tio n, o r th e A m eric a n H ealt h In fo rm atio 3. T he p aper s h ould b e a t le ast 2 –3 p ara gra phs in le ngth fo r e ach q uestio n ( n ot i 4. T he p aper s h ould fo llo w th e c o nve ntio ns o f S ta ndard A m eric a n E nglis h ( c o rre c 5. Y our w rit in g s h ould b e w ell o rd ere d, lo gic a l, a nd u nif ie d, a s w ell a s o rig in al a nd co nte nt, o rg aniz a tio n, s ty le , a nd m ech anic s. 6. Y ou s h ould c it e s o urc e s u sin g A PA fo rm at. 7. P re se nta tio n m ust b e p ro fe ssio nally a ttr a ctiv e . Im porta n t: P le ase b e s u re to v is it A ca dem ic S ucce ss C ente r: W rit in g C ente r to th is A ssig nm ent. S ubm it tin g y o ur w ork : P ut y o ur r e sp onse s in a W ord d ocu m ent. Y our ta ble o r g ra ph m ay b e c o pie d a nd su bm it te d s e para te ly . S ubm it y o ur w ork to th e a ppro pria te D ro pbox. G ra d in g C rit e ria : 11/1/2020 Unit 7 Assignment – HI410 Advanced Reimbursement Methodology https://purdueglobal.brightspace.com/d2l/le/content/143224/viewContent/10715241/V iew 7/7 Refle ct i n e P ortfo li o D ow nlo ad P rin t B e s u re to r e vie w th e g ra din g r u bric fo r th is A ssig nm ent. T a sk : V ie w t h is t o pic A ctiv it y D eta ils

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