Global Medicare Medicaid Prospective Payment Systems Discussion

In this Discussion, review the following concepts pertaining to Medicare-Medicaid prospective payment systems for post-acute care (PAC): Post-acute care (PAC) provides patients with healthcare services for their recuperation and rehabilitation after an illness or injury.

Name the three dimensions of case mix measured using data elements from OASIS for the home health prospective payment system and provide detail explanation for each.
Explain how the utilization review process supports the payment system

Discussion Post #2

In this Discussion, review the following concepts pertaining to revenue cycle management: To maintain profitability under the prospective payment systems, healthcare facilities are incentivized to constantly examine and implement methods to either increase reimbursement or decrease costs.

List the ways discrepancies between submitted charges and paid charges are reconciled by the provider.
What fraudulent acts can be identified in this process?

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