Assignment

Paper 1

Case Study: You are assessing the payer-patient mix for a health care organization. Currently, your payer mix is 40% Medicare, 10% Medicaid, 25% traditional indemnity insurance, 20% managed care, and 5% self-pay patients. Complete the following:

Using the most common office visit, CPT code 99214, determine the reimbursement from the Centers for Medicare and Medicaid Services (online fee schedule available for Medicare).

Using the same CPT code, 99214, determine the reimbursement for Medicaid (fee schedules should be available from the individual state).

Using the same CPT code, 99214, create at least 3 other traditional indemnity insurance reimbursements. If possible, use the actual reimbursement from the insurance carrier. It may be possible to obtain actual reimbursement information from your personal insurance carrier. If the information is not available, assume reimbursement by traditional indemnity insurance is usually 200% reimbursed more than Medicare and Medicaid, and managed care is usually 133% more than Medicare and Medicaid.

Compose an accounts receivable benchmark from this information showing columns for current, 30-60, 61-90, 90-120, and greater than 120 days.

Assess the information for areas of improved reimbursement of at least 20% or more.

Evaluate the options available to change the payer-patient mix with consideration of related legal and ethical issues.

Propose a best strategy with justification and rationale based on effective decision-making tenets.

The body of the resultant paper should be 10-12 pages. Spreadsheets demonstrating the accounts receivable analysis will be attached as appendices, and there will be at least 7 relevant peer-reviewed academic or professional references published within the past 5 years. Also attach appropriate fee schedules

Paper 2

Choose a health care issue with controversial ethical and legal implications that was at the center of a high visibility case in the public domain. Some examples of issues include but are not limited to the following:

Late term abortion

Assisted suicide

Surgical errors

Patient abuse

Parental refusal of medical treatment of minors for religious reasons

Transplant patient selection process

Access to clinical trials by terminal patients

Gender assignment for infants born with intersex anatomy

Survivor selection in conjoined twins

Access to illicit drugs for palliative care

Withholding hydration or nourishment

Life support continuation for brain-dead patients

Medical treatment for the elderly or terminally ill

Donor organ harvesting

Use of placebo in clinical trials

Use of patient data without consent

Stem cell research and treatments

Access to treatments not yet approved by the U.S. Food and Drug Administration (FDA)

Note: There is no time frame during which the case must have occurred for this assignment. Please note, however, that any case selected must be analyzed in the context of laws and policies that existed at the time of the case in addition to current laws and policies.

Perform research in the University library using at least 8-10 relevant peer-reviewed academic or professional journal articles that were published within the past 5 years, and complete the following to prepare your report:

Analyze the ethics of the case from each end of the ethical spectrum (ultraconservative to ultraliberal) from the perspective of 3 of the following stakeholders:

Patient,

Patient's immediate family or guardians

Emergency medical personnel or first responders

Doctors, surgeons, specialists, or other medical providers

The hospital or health care facility

A pharmaceutical or medical device company

Identify policies at the federal, state, and local levels relating to the provision of health care and patient rights that played the following roles in the case:

Assesses opposing views of these policies from the perspectives of the provider and patient

Analyzes the implications of these policies on the operations of health care organizations

Identify at least 3 state or federal laws that are relevant to the case, and complete the following:

Evaluate key legal factors that are inherent in the case.

Assess various policies and procedures that are inherent in these laws that relate to the provision of health care by providers or patient rights.

Differentiate between the demands of legal policies and ethical issues with relevance to the needs of the provider and patient.

Formulate an assessment of the potential impact of the case on decision-making options in the future for providers, patients, and administrators.