Business Commons^™

Upcoding Medicare: Is Healthcare Fraud And Abuse Increasing?, Alberto Coustasse, Whitney Layton, Laikyn Nelson, Victoria Walker

Management Faculty Research

Medicare fraud has been the cause of up to $60 billion in overpaid claims in 2015 alone. Upcoding occurs when a healthcare provider has submitted codes for more severe conditions than diagnosed for the patient to receive higher reimbursement. The purpose of this study was to assess the impact of Medicare and Medicaid fraud to determine the magnitude of upcoding inpatient and outpatient claims throughout reimbursements.

The methodology for this study utilized a literature review. The literature review analyzed physician upcoding throughout present on admission infections, diagnostic related group upcoding, emergency department, and clinic upcoding. It was found that upcoding …

Potential Savings From Consumer-Driven Health Plans, William Ferguson, Brittany Smith, Jessica Mcnair, Sarah Miller, Bojing Wang, Alberto Coustasse

Management Faculty Research

Consumer Driven Health Plans (CDHPs) have been identified as a high-deductible insurance option that has increased consumer responsibility while healthcare expenditures have decreased. There has been an increasing need of these plans because they can help to control healthcare costs, and the increasing healthcare utilization. As the use of these plans have expanded, educated consumers have become more engaged in their healthcare services and have increased demands for transparency of healthcare costs. The methodology for this study was a literature review using 36 sources. The purpose of this study was to determine if CDHPs have created financial savings by increasing …

Black Swan To Phoenix: The Role Of Dynamic Capabilities, Ambidexterity And Corporate Insight, Marc D. Sollosy

Management Faculty Research

The paper presents the position that in times of Black Swan or other unforeseen or unprecedented events the path to survival is not the sole function of the company’s strategy. While much has been written about the need for companies to alter or adapt their strategies in face of such events, doing so is easier said than done. In fact, strategy is foundational and a function of and subject to the capabilities of the company. That there is no real strategy or strategy altering approach for preparing for a Black Swan like event.

The paper provides insights and alternative view …

Charge Masters And The Effects On Hospitals, Whitney Layton, Katie Lemmon, Alberto Coustasse

Management Faculty Research

The hospital chargemaster has been the heart of the healthcare revenue cycle, as it has served as the hospitals’ starting point for billing patients and payers. The CDM was made as an extensive breakdown of the cost of the care provided and in order for a hospital to correctly bill a patient for care received as every chargeable item in the hospital must be included in the master. The methodology for this study utilized a literature review. It consisted of academic sources, electronic databases, academic journals, and government websites. Thirty-eight sources were referenced for this literature review. The literature review …