Discussion 7

Refer to the payment determination in the textbook. Review the process by which hospitals submit claims for reimbursement from Medicare-related programs. Then, assuming the role of a healthcare administrator of a hospital, imagine that your office is having difficulty tracking reimbursed claims. Describe one way that claim submissions can be improved and what control procedures you will put in place to monitor claims to ensure payments are received. 

Reference : Textbook: Principles of Healthcare Reimbursement Systems and Finance, Chapter 7

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Payment Status Indicator Categories
To understand how an encounter is reimbursed under OPPS, the various categories of SI must be correctly applied. However, when determining encounter reimbursement, each category cannot be assessed in isolation. Instead, all SIs must be used in combination to correctly determine reimbursement under OPPS. There are nine SI categories currently used in the OPPS:
•APC Payment
•Per Diem APC Payment
•Comprehensive APC Payment
•Conditional APC Payment
•Composite APC Payment
•Packaged Payment
•Fee Schedule Payment
•Reasonable Cost Payment
•Services Not Reimbursed under OPPS

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