Ambulatory Care Case Study

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Fees paid to ambulatory care centers by Medicare part B provided they follow the approved standard guidelines of the federal standard set aside, for the surgical procedures. The codes used for billing standards for each type of procedures they provide in which Medicare use other third-party payers following in their footsteps. Before the center can receive payment the procedure is assigned a code. Depending on the code assigned to the surgical procedure, Medicare determines if the order justifies the charge based on Federal regulations. They also assign diagnosis codes from the International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) to describe the reason for which the patient received surgery in an outpatient setting (Medical Building and Coding). …show more content…
The guideline provision is provided by the Health Insurance Portability and Accountability Act of 1997 (HIPAA). Furthermore, other sources for payments for services provide as in a collective benefits package, besides the surgery. It also includes before and after care for the surgery and an extended 24-hour observation period if necessary.
Explain the differences in reimbursement between ambulatory care centers and traditional hospitals?
Inpatient hospital reimbursement under CMS’ payments prospective payment system agrees to predetermined rates in order to serve Medicare patients ( Adamopoulos, 2014). About 3,400 acute-care hospitals and 435 long-term care hospital receive payments under the IPPS (Adamopoulos, 2014). Compared to the ambulatory care centers they are considering agreement payment which is pre-determine how much Medicare will pay for a