Claims Processing Case Study Analysis
Correct claims processing is vital to the financial security of a healthcare facility. Errors in processing claims can lead to denial, underpayment, or overpayment of services rendered. All of these can have an immediate or future negative impact on healthcare providers and suppliers. We can see this happening in the example of Mosaic Internal Medicine in this week’s Introduction. There are many rules and regulations that make claims processing complex and susceptible to error.
In this Assignment, you examine a case study involving claims processing for services covered by Medicare. You will propose a plan of action that outlines how claims processing can be improved between Medicare contractors and healthcare organizations to avoid future claim errors.
To prepare for this Assignment:
- Read the document, “Case 3: Claims Processing,” found in this week’s Learning Resources.
- Consider how data shown on healthcare claims are used when issuing payment for services rendered.
- Imagine you are in the role of executive for Wisconsin Physician Service (WPS) Insurance Corporation.
The Assignment (2- to 3-page paper):
After reading the case study thoroughly from the perspective of the executive, respond to the following:
- Propose a plan of action to the Board of Directors outlining a response to the Office of the Inspector General (OIG).
- Recommend at least one suggestion for how the process between WPS and CMS (Centers for Medicare and Medicaid Services) could be improved.
Provide specific examples in your paper. Support your post with the Learning Resources and at least one outside scholarly source.