The payment determination form located in Chapter 7 provides an example of the various criteria that healthcare administrators must meet prior to submitting claims to Medicare for related programs. The example demonstrates that healthcare administrators work to develop processes and procedures for employees to ensure claims are completed properly and in a timely manner. With the many required criteria on these claim forms, properly completed, timely forms are often the focus of many healthcare administrators. Many administrators provide training on certification standards. In some cases, administrators will send employees for training on Medicare standards.
Refer to the payment determination in the textbook. Review the process by which hospitals submit claims for reimbursement from Medicare-related programs. Then, assuming the role of a healthcare administrator of a hospital, imagine that your office is having difficulty tracking reimbursed claims. Describe one way that claim submissions can be improved and what control procedures you will put in place to monitor claims to ensure payments are received.
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