SOLVED247

Task : This Reimbursement Monitoring and Reporting (RMR) Checklist provides students with opportunities to investigate realistic claims rejection cases that are “written off” in an outpatient setting and write recommendations that provide guidance to providers, practice managers/staff, and medical billers. This activity integrates the importance of documentation, compliance, coding quality, management and leadership. The RMR Checklist consists of two parts. This counts as 10% of the course grade. Part I : Calculation of Physician Fee Schedule of Monthly Write off and Recommendation. There are seven “write off” scenarios in an outpatient setting “Outpatient Monthly Write off CY ___ Quarter 2016,” which students will provide recommendations related to: poor documentation; no authorization; frequency issues; coordination of benefits; downcoding of E/M codes; unbundling of procedure codes; Medicare reimbursement policy regarding assistant surgeon. Calculate the physician’s fee for every service performed per month using the www.CMS.gov site Physician Fee Schedule website. Add the total amount per month. For documentation issue recommendation, students will query physician and/or educate physician; design and complete the documentation requirements of Operative Report and indicate documentation needed to support procedures and diagnosis. For authorization and frequency issues recommendation, students will create a practice policy to implement ABN for Medicare
SCIENCE
HEALTH SCIENCE
NURSING

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