What does administration need to do to ensure that the hospital is not submitting claims for services for which payment is not available under applicable rule?
1) What are the factors (e.g., timely and appropriate clinical services) that determine whether patients at risk for pressure ulcers receive proper skin care?
2)What does administration need to do to ensure that the hospital is not submitting claims for services for which payment is not available under applicable rule? Take into account the role of individuals who may want to become a whistleblower, or qui tam relator under the False Claims Act.
3)Legally, how did CMS go about deciding that it would reduce reimbursement for hospital-acquired pressure ulcers and other conditions? Does this policy make sense to you? Why? Does the policy raise any ethical issues?
4)In what ways might an administrator alter systems to avoid the adverse conditions impacting payment, as described in this scenario? In particular, what, if anything, might a hospital administrator do regarding the skilled nursing facility from which this and other patients come?
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