Discussion: Reimbursement Schedules

Please review the discussion board rubric under “Start Here”.

Use in-text citations appropriately and provide full citations for your initial post and at least one of your response posts. One of your citations needs to be outside of your text.

The idea is that you would not only comment on your classmate’s post but also do some additional research furthering the discussion.

To begin discussing in this forum, click the forum title, “Week 2 Discussion”. Then, click Create Thread on the Action Bar to post your initial reply. To reply to a fellow participant, click the title of the initial post, then click Reply.

PEER RESPONSE 1

Chenelle Weaver

Week 2 Discussion (Initial Post) Discussion week

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Total views: 2 (Your views: 2)
How does the location of where a service is performed determine which code set is used. Relate issues such as reimbursement schedules, co-pay amounts, and coverage limitations.

Where the service is or was provided determines the code that is used. Every place has its own set of codes. Payers have different reimbursement schedules, co-pay amounts, or coverage limitations depending on the place and/or location of service, this allows for proper billing to Medicaid, Medicare, or other private insurance companies.

What is a fee schedule?

According to www.cms.gov, “A fee schedule is a complete listing of fees used by Medicare to pay doctors or other providers/suppliers. This comprehensive listing of fee maximums is used to reimburse a physician and/or other providers on a fee-for-service basis. CMS develops fee schedules for physicians, ambulance services, clinical laboratory services, and durable medical equipment, prosthetics, orthotics, and supplies.”

What is a co-pay?A co-pay or copayment is a flat fee that you pay on the spot every time you go to your doctor or fill a prescription. For example, if you hurt sprain your wrist or refill a prescription for an asthma inhaler, the amount you pay for that visit or medicine is considered your co-pay. Your co-pay amount is usually printed right on your insurance card. If your health insurance plan pays 100% for annual check-ups and preventive care services, you may not have a co-pay for those visits.

What types of services does the term “procedure coding” include?

Procedure coding include all healthcare related services like – Medicare, hospital services, ambulance services, insurance coverage services, non-physician services etc.

Discussion: Reimbursement Schedules

Discussion: Reimbursement Schedules

Word Count: 265

References:

www.cms.gov retrieved on June 14, 2017

www.healthcare.gov retrieved on June 14, 2017

Aalseth, P. (2015). Medical Coding What Is and How It Works. (2nd Ed) Burlington, MA: Jones & Barlett Learning

PEER RESPONSE 2

Quetsy Garcia

discussion week 2 Discussion week

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Total views: 9 (Your views: 2)
How does the location of where a service is performed determine which code set is used.
Procedure codesare a sub-type of medical classification used to identify specific surgical, medical, or diagnostic interventions. The code plays an essential role in patient access to new and existing technologies for the following reasons: It enables providers and payers to identify with specificity, for billing and claims processing purposes, the product that was provided to a patient. It serves as a means to define a health care product and provide a common identifier for providers and payers for obtaining data that measure outcomes and cost.

2. What is a fee schedule:

A fee schedule is a complete listing of fees used by Medicare to pay doctors or other providers/suppl. This comprehensive listing of fee maximums is used to reimburse a physician and other providers on a fee-for-service basis.

3. What is a co pay:

A payment made by a patient in addition to that made by an insurer.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865619/

Discussion Board Rubric

Discussion Board: Participation and Professionalism Rubric

Expectations and Points Awarded

Exemplary

Acceptable

Needs Improvement

Unacceptable

Posting Requirements

50 pts

Student always posts to the discussion board on three separate days within the week. Proper APA format is used for in-text citation and referencing in the initial post. The student writes in a scholarly tone demonstrating critical thinking that goes beyond just sharing opinions. Student demonstrates ability to cite sources in proper APA.

50 pts

Student does not post on three separate days of the week, but posts on two separate days of the week.

35 pts

Student posts only one initial response to the discussion board.

20 pts

Student does not post an initial answer to address the topic or answer the question, and/or does not make any responses at all.

0 pts

Level of Engagement and Participation

15 pts

Student posts promote further discussion by offering ideas and asking questions that are relevant to the discussion and course material. The posts offer an expansion on other student’s posts and course material.

15 pts

Student contributes to the class by posting but offers only a few ideas and asks questions that promote discussion on occasion but not all the time.

10 pts

Student rarely contributes to the discussion by offering ideas and asking questions.

3 pts

Student never contributes to the discussion by offering ideas and asking questions.

0 pts

Response Skill

15 pts

Student responses demonstrate they have read their classmates post. Their response indicates they are furthering the discussion by building on the post their classmate made. Proper APA format is used for in-text citation and referencing. The student writes in a scholarly tone demonstrating critical thinking that goes beyond just sharing opinions. Student demonstrates ability to cite sources in proper APA.

15 pts

Student responses often, but not always, indicate they have read their classmate and instructor posts.

10 pts

Student responses rarely demonstrate an understanding of other posts and course material.

5 pts

Student posts do not demonstrate they have read the material or other students’ posts.

0 pts

Posting Behavior

10 pts

Student demonstrates a professional level of respect for learning while participating on the discussion board. This level of respect is shown through behavior and attitude.

10 pts

Student posting is usually respectful. There is no display of disruptive posting.

7 pts

Student posts sometimes display a lack of respect or professional writing behavior, including rules of Netiquette

3 pts

Student is often disruptive by posting posts that are not respectful, do not demonstrate professionalism, or breach Netiquette rules.

0 pts

Preparation

10 pts

Student is always prepared with discussion posts that demonstrate a commitment to reading the course material and posts. The student’s post contains scholarly support for ideas by citing credible references

10 pts

Student is usually prepared with posts that demonstrate some understanding of the topic.

7 pts

Student is only occasionally prepared for class with posts that demonstrate they have read the course material and posts from the Instructor and other students.

2 pts

Student is never prepared for class with assignments and required class materials.

0 pts

DBRubric7.16.2014.pdf

Workplace Safety and Ethics
Workplace safety is important for employees, patients, and business partners.

Create a 2-page assignment, APA formatted with a separate reference page, which discusses how OSHA helps healthcare providers should provide a safe office space for their stakeholders.

Your assignment should, but is not limited to, processes for disposal of toxic waste, removal of non-sanitized materials, display of proper signs, etc.

 

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