Question

As a financial manager in a health care organization, it is very important to understand the regulatory and legal environment as it dictates insurance laws payment regulations, delivery of service and communication with federal and state agencies.

Assignment 1. From a financial point of view how does fee for service payments under Medicare differ from fee for services from traditional indemnity?

Assignment 2. Discuss what is a corporate compliance plan. List the risks of the Health Care Organisation not complying with corporate compliance plan. Who is responsible for internal control?

Assignment 3. List the different Medicare plans.

Assignment 4. Why do you think it is important for health care financial management to pay attention to legislation from United States Congress and its state legislature? Discuss two pieces of legislation that have changed health care financial management and why.

Answer 1

1. Under the traditional indemnity approach the fee is fixed based on the predetermined list based on the disease however in the Medicare approach it's based on the actual bill.

2. Corporate compliance plan involves a control via checking of companies financial statements to ensure there is no fraud or non compliance to the law and policies incase there is no compliance a fine has to be paid there is an internal auditor responsible for audit.

3.medicare advantage plan and other Medicare plans which include cost plans, pilot programs , inclusive care for elderly and medical therapy management.

4. Legislation is important to be followed to avoid bans and fines.legislation with regards to audit requirements to avoid frauds and plans for clinical practice improvement activities are examples of legislation.