Medicine and Health Sciences Commons^™

Implications Of Upcoding On Medicare, Katrina Cremeans, Samantha Marcum, Carli Followay, Jessica Oldaker, Alberto Coustasse

Management Faculty Research

The complexity of and amount of funds involved in Medicare has led to a significant increase in the incidence of Medicare fraud. A type of Medicare fraud, upcoding, has contributed to excessive and unnecessary health care spending. Upcoding has been an illegal strategy that some providers have used to increase their Medicare reimbursement for certain conditions. This is accomplished by coding a provided service as a more expensive service than what was actually performed. With the proliferation of upcoding, there has been an astonishing $12.5 billion in fraudulent Medicare charges since 2007. The fraudulent strategy of upcoding to increase Medicare …

The Use Of Big Data By Managed Care Organizations, Bojing Wang, Xiaoying Liu, Alberto Coustasse

Management Faculty Research

Big data have become available in all kinds of healthcare organizations. The application of big data analytics in Managed Care Organizations (MCOs) has the potential to improve health care, lower costs, save lives, and help to make better-informed decisions. The study illustrated the implication of big data in MCOs. Big data can help MCOs reduce patients’ relevance, analyze specific diseases such as asthma and diabetes. Big data also could help MCOs to reduce cost after collecting data and determined the specific patients’ situation. The implication of big data has benefited MCOs in reducing costs, improving the quality of healthcare care. …

Potential Savings From Consumer-Driven Health Plans, Jessica Mcnair, Brittany White, Christopher Miller, William Ferguson, 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 health care expenditures have decreased. Anticipated savings through the use of CDHPs have drawn increased interest of employers and policymakers. The increased need to control healthcare costs as well as healthcare utilization have also fostered the development of increased use of CDHPs. As the use of CDHPs have expanded, educated consumers have become more engaged in their healthcare services and have increased demands for transparency of healthcare costs. Healthcare costs, utilization, and moral hazard of this study are further discussed.

Charge Master And The Effects On Hospitals, Whitney Layton, Katie Lemmon

Theses, Dissertations and Capstones

Introduction: The hospital charge master, 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.

Methodology: The methodology for this study utilized a literature review. It consisted of academic sources, five electronic databases, academic journals, and government websites. Thirty- six sources were referenced for this …

Rural Hospital Health In The United States, Stephanie Cole, Kathleen Lanham

Theses, Dissertations and Capstones

Introduction: Rural hospitals experienced both challenges and opportunities in providing healthcare to the community. As these facilities were one of the largest employers in the area, their impact was significant. Additionally, accessibility to necessary medical services was essential. Thus, sustainability of rural hospitals was vital. In order to assess sustainability, exploration into financial and quality outcomes could help support their ability to thrive.

Purpose of the Study: The purpose of this study was to determine the sustainability of rural hospitals in the U.S. by examining variables that affect these institutions such as accessibility, availability of services, quality outcomes, and …

The Utilization Of Telehealth/ Telemedicine In Cardiology In Rural Areas, Sophia Noplis, Jocelyn Stout

Theses, Dissertations and Capstones

Introduction: Telecardiology has been defined as a way of practicing cardiology through the utilization of telecommunications and a more cost-effective way to deliver cardiac care. As a subset of telemedicine, telecardiology has functioned to bring providers to underserved communities through technological mechanisms. Rural regions have turned to telemedicine and tapped into a network of clinical institutions exchanging practitioners and patients to emphasize value-based instead of volume-based care.

Methodology: The methodology of this qualitative study was a literature review having used mixed methodologies. Five electronic databases and government websites were utilized, and one semi-structured interview with an expert in …

The Implementation And Effects Of Computerized Physician Order Entry In Healthcare Settings, Bojing Wang, Xiaoying Liu

Theses, Dissertations and Capstones

Introduction: In the United States, medication errors has been a big problem and was the number three cause of death in 2016. Computerize Physician Order Entry (CPOE), also known as Computerized Provider Order Entry, is the process of physicians or providers entering treatment instructions or radiology, laboratory, and medication orders via computer rather than paper, and has led to a decrease in medication errors. The purpose of this study was to examine whether CPOE system could help hospitals to reduce medical errors and costs, as well as examine the new problems resulted by the use of CPOE in the …