1. Introduction (25%) Provide a brief synopsis of the meaning (not a description) of each Chapter and articles you read, in your own words that will apply to the case study presented.

2. Your Critique (50%): Case Study

 Medical Business Operations: Actualization

Recently, The Superior Care Health Group (SCHG) has been experiencing a large percentage of billing rejections from various third-party payers. Although there are many reasons for the claim rejection, the main problem is Inaccurate billing codes, specifically those as ICD-10 codes.

The office manager, Mr. James Hopkins MHSA, who is new to SCHG, suspect that the problem is with the group’s old billing software. When an office associate is given medical chart information to code, the software only provides a list of potential ICD-10 codes when the physician’s diagnosis is keyed and entered into the system. It is up to the office associate to make the determination between diagnosis that are very similar and difficult to differentiate.  Mr. Hopkins knows that newer software can make the code differentiation more automatic and accurate.

CASE STUDY CHALLENGE

  1. How and where Mr. Hopkin can start with this project?

  2. How can Mr. Hopkins address these issues?

  3. Where should he start his research?

  4. Once all change are done, which ones will be future results? Describe and explain all of them in detail.

3. Conclusion (15%)

Briefly summarize your thoughts & conclusion to your critique of the case study and provide a possible outcome for the Health Care Center.  How did these articles and Chapters influence your opinions about Health Care Computer Application?

Evaluation will be based on how clearly you respond to the above, in particular:

a) The clarity with which you critique the case study;

b) The depth, scope, and organization of your paper; and,

c) Your conclusions, including a description of the impact of these Case study on any Health Care Setting, Law and Legislation.

chapter_7.pdf

chapter_8.pdf

healthguide.pdf

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