Reimbursement rules

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1. Reimbursement rules require that the chargemaster drives a facility’s charges. To receive the optimal reimbursement for services rendered, the chargemaster must be up-to-date and all-inclusive and must meet any payer rules and regulations.

The UMUC facility has decided to undergo a review of its chargemaster to ensure that it meets the above criteria. In addition to the comprehensive evaluation, one of the other objectives of the project will be to institute the procedures to ensure that all additions, revisions, and deletions meet the chargemaster standards. In a minimum of 250 words, respond to questions below. Once your material is posted, be sure to review and comment on at least two of your peers postings. Your initial post to the given topic of discussion should contain a minimum of 2–3 peer-reviewed references.

  • How could the facility measure the success of the chargemaster review project?
  • Which facility departments should be included on the project team? Describe the role and responsibilities of each team member?
  • Who would be the most appropriate project sponsor? Who are the project stakeholders?

2. In a minimum of 250 words, explain how fee for service and capitation payment systems affect the physician’s role as the patient’s agent? Second, the move from cost-based payment for hospital services to payment on DRGs was expected to change hospital behavior. Discuss what you would have expected to observe as payment methods changed?