For the Unit VII PowerPoint Presentation, you will assume the role of a candidate interviewing for the director of medical billing at Columbia Southern Medical Group. The interview panel has provided you with five questions, and they would like you to create presentation slides with your response(s). Below are the five interview questions..
- Columbia Southern Medical Group is an organization that prides itself on being on the forefront of innovation. By fulfilling this role as the director of medical billing, you would be expected to maintain knowledge on health insurance developments and new strategies in the field. What three recent developments in health care have influenced the climate of reimbursement the most, in your opinion? Be sure to detail each development. (two slides)
- Some of your tasks as director of medical billing will lead you to be involved in Columbia Southern Medical Group’s medical coding procedures. Seeing that Columbia Southern Medical Group provides both inpatient and outpatient services, explain the types of medical coding that will be used in your department. Explain the relationship between the coding and billing departments and identify some of the issues that could arise with incorrect coding/billing. (two slides)
- Columbia Southern Medical Group does accept Medicare assignment in most cases, but there are two facilities owned by Columbia Southern Medical Group that do not participate with the Medicare program. With what you know about the Medicare Physician Fee Schedule (MPFS) and how it differs regarding participating providers versus non-participating providers, outline the differences in how these separate entities would conduct payments with this system. It may be a good idea to provide an example with the two different calculations describing how a service or procedure would be reimbursed under these scenarios. (two slides)
- Being in compliance with health care regulations is of the utmost importance to Columbia Southern Medical Group, and it is imperative that all of its departments operate ethically and with integrity. One of your tasks as director will be to implement policies that will provide protection and security of all sensitive data housed in your department. Name safeguarding techniques that you will use to ensure privacy and security of patient information. Furthermore, describe regulatory standards and/or health care laws that will explain and enforce compliance measures. How do these measures help combat fraud and abuse? Additionally, describe how Explanation of Benefits (EOBs) can further reduce fraudulent situations and assist staff with the insurance claim review process (three slides)
- Columbia Southern Medical Group has always worked hard to create an atmosphere of continuous improvement as that has shown to lead to a more quality experience for the patient. By keeping up with current trends in the industry as well as ensuring that all regulatory and legal requirements are met, Columbia Southern Medical Group will continue to provide quality unmatched by others. One regulatory requirement that you will be tasked with as the director of medical billing is auditing. What are some health care third-party audits specific to medical billing and coding of which you will need to be knowledgeable? What are your thoughts on random self-audits? Do you think they can be helpful to you and your department if you were to obtain this position? (two slides)
Your presentation should consist of a total of 10 slides, not counting the title and reference slides.
