Career Connect Essay
• Explain compliance with regulatory requirements and reimbursement methodologies.
Your manager would like you to identify the following items in your essay:
• Identify and explain in detail the False Claims Act and it’s impact on Medicare and Medicaid programs.
• Define fraud and abuse. Describe why it is important to follow CMS regulatory requirements to avoid fraud or abuse in billing and coding practices? Justify your answer.
• Explain the Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS) reimbursement methodologies and determine when they are used. Explain the four reimbursement methodologies used in each of the settings of care below:
o Inpatient Acute Care Hospital
o Skilled Nursing Faciltiy
o Outpatient Facility
o Physician Office