HCA270 WK 1 DQ 2
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This 0 page Study Guide was uploaded by an elite notetaker on Tuesday November 10, 2015. The Study Guide belongs to fin571 at Kaplan University taught by in Fall 2015. Since its upload, it has received 24 views.
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Date Created: 11/10/15
What types of agency problems do health care organizations face There are several agency problems such as Staffing The nursing shortage is a good example of agency problems The nurses are the principle and the agent is the hospital The nurses are the principle and the hospital agent is reacting to the nurse s request They offer a service that they can put the demands on the table and request higher pay more exible hours and shift such as a program called Bid a shift Cost Control Director of Finance is the agent When determining salary for an employed physician Whose compensation is productivity based The physician is quoted a salary that he is not happy With Depending on the reaction the physician has regarding this salary this could generate another agency problem Since the provider is compensated on productivity he could go back to the practice and perform xrays EKG s prescribe medications and charge level 5 visits to increase his productivity Reimbursement from payers Physicians order test on their patients that are not medically necessary The facility does not receive payment by the insurance carrier and the patient unexpectedly receives a large bill for these non covered services How are agency relationships such as that between patient and physician related to cost Ineffective cost management is a real agency problem for physician practices The case for this problem is inappropriate use of resources Ordering unnecessary testing not providing payable diagnosis codes for test that are being ordered Especially if the providers are compensated on generated charges not collections Physicians direct their patients the hospital of their physician choice This is for their own personal gain such as the physician may utilize the hospital medicine services so he does not have to go to the hospital and see the patient or because the hospital is closer and more convenient for the physician What are some possible methods of resolving these agency problems Physician can be placed on a compensation model base on the WRVU rate set by Medicare There is an option to alter the WRVU rate for individual organizations One option is do not pay the WRVU rate for ancillary testing and pay a higher WRVU rate for the actual EampM codes This would prevent unnecessary testing being order to increase compensation For staffing purposes offering a Bid a Shift program will improve the employees moral and decreases staff turnover Staffing turnover is very expensive Offering incentives for the percentage of ancillary testing that is order that is processed as a clean claim on the first try Reward the positive behaviors instead of negative Provide additional coding session for the providers that are having problems Under coding equates to lost revenue over coding can become an auditing concern This is where an internal coding auditor would be beneficial Investing in a computer program that will link the diagnosis to the appropriate ancillary test would also be cost effective As a hospital it is very advantageous to encourage the primary care physicians to admit their patients to the hospital medicine physicians The reason is bed turnover Research has proven that hospital beds are turned over quicker by facilities that have hospital medicine programs These physicians are located in the hospital 7 days a week 24 hours a day Patients are discharges throughout the day of only morning and after clinic This can be very beneficial to a hospital especially with Medicare and Medicaid patients
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