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Conditions of Participation

Go to http:// www.cms.hhs.gov and find the Conditions of Participation. Read the Conditions of Participation and discuss the standards listed.
In your initial response, answer the following questions.
1. Are there any specific actions or elements that you think are missing?
2. Locate and review the Comprehensive Error Rate Testing results in your state. Look through the list of elements studied by this evaluation of claims payments.
a. What surprises you most?
b. Are there any additional areas that you believe should be measured?
c. Had the facility been evaluated by a CERT, what would you do to improve performance?
3. Identify the fiscal intermediary in your state and go to their website.
a. What information is there that would help you with writing a compliance program?
b. What details can you find relating to:
c. Medicare claims processing
d. Medicaid claims processing
4. Research the details of the federal False Claims Act.
a. What aspects of this law do you believe to be most important?

Solution Preview

Go to http:// www.cms.hhs.gov and find the Conditions of Participation. Read the Conditions of Participation and discuss the standards listed.
In your initial response, answer the following questions.
Are there any specific actions or elements that you think are missing?
The document is quite extensive but I did not see where the elements that were seen as important in hospital care did not transfer over to the physician's care. These were the pneumonia vaccine and the care of the chronic patient. These patients are some of the main consumers of Medicare and Medicaid and need to be included in the dialogue. Also, there needs to be more emphasis on wellness and how this will impact the future of the care of the patient.
Locate and review the Comprehensive Error Rate Testing results in your state. Look through the list of elements studied by this evaluation of claims payments.
What surprises you most?
The improper payments report for Texas was 6% or less than nationwide. They also had greater than $841million dollars in 2011. This was the result of errors related to no physician signature, documentation not matching the code biller, inability to find hospital record and illegible handwriting.
Are there any additional areas that you believe should be measured?
In searching for customer satisfaction rates, there was not clear data to support any programs that were being used to collect data. A ...

Solution Summary

The conditions of participations are examined. The specific actions or elements missing are determined.

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