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 compliance with regulatory requirements and reimbursement methodologies.

Directions

You are a lead coder at Bryant City Hospital and have been asked by your manager to prepare an essay to be included in the training manuals for incoming employees to the HIM department. This essay must educate new employees about The Centers for Medicare and Medicaid Services (CMS) regulatory requirements and the different types of reimbursement methologies used in various settings of care. Your essay should be at least 500 words, thoroughly address each prompt, be free of grammar and spelling errors, use complete sentences and be organized in manner that makes sence to new employees. Rescources from your course material (already in APA format) should be used as supporting evidence. All resources used should be listed on the reference page.

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