Chapter 4, Problem 23R

What are the provisions of the False Claims Act in healthcare reimbursements?

Are telehealth and telemedicine services billable to the patients insurance coverage the same as face encounters in the office or hospital setting?

To process claims accurately and effectively, billing professionals must understand how a clean claim is prepared and what issues can contribute to a dirty claim. When managing a team of billing professionals, it is important to understand how internal and external factors contribute to a smooth process vs. a rejection or denial. Summarize internal factors (within your organization/facility) that can positively or negatively influence the life cycle of a claim. Summarize external factors (outside of your organization/facility) that can positively or negatively influence the life cycle of a claim. From a leadership perspective, how can you ensure your team is effectively trained and confident in navigating internal and external challenges with claim processing? Please be sure to validate your opinions and ideas with citations and references in APA format.

Describe how health insurance participation may or may not contribute to a denial and how  can it be communicated with the insurance company when filing an appeal.

How does health Insurance Portability and Accountability Act (HIPAA) facilitate electronic transactions? A Gives providers access to a centralized patient database B Gives covered providers unique identifiers to use with coding system C Allows anyone with computer access to file claims D Generates paper reports as a back up system

Nursing Homes Assistant Identify the most common form of litigation in Nursing Homes. Describe a situation in which an individual in this profession might be held liable for negligence and ways to proactively avoid or prevent negligence in the profession that you selected.

Please respond to the questions regarding this hypothetical case: An eastern state enacted a law prohibiting liquor retailers from advertising in the media.  The state reasoned that advertising liquor encouraged drinking which was against public policy.  A local liquor store sued the state seeking declaratory relief.  The store argued that the law denied their right to due process.  The store won at trial.  The court found no evidence that the law had a significant effect on liquor consumption.  The state appealed and the decision was reversed in their favor.  The liquor store then appealed to the U.S. Supreme Court. The liquor store sought “declaratory relief.”  What does that mean in the context of this case?  What did the store want the court to do?

I need help with a respiratory question? What does The False Claims act do for each individual health care worker? Group of answer choices   It provides protections to hospital workers whether they are organized into a union or not. Permits an employee with knowledge of fraud or false billing to file a lawsuit against the company or organization engaging in fraud ion. It provides legal aid only for those in an organized union. It oversees the hospital’s business practices.

1.) A medical group has decided to develop an industrial medicine program for employers. This program would help in the treatment of on-the-job injuries, workers’ compensation requirements, health education, and toxicology analysis. The group has hired a new salesperson to approach a major furniture manufacturer about the program. In preparing for her first call, the salesperson makes a list of the possible members of the buying center. Prepare the list and explain each idea. Note-please do not list furniture manufacturers or companies!