Information Systems 3 assignments

This week we will be learning about utilization management.  Utilization management sometimes ends in the denial of payment for a service.  If you were to have a service denied for payment by your health plan, do you know how you would appeal that decision?  Many consumers do not.

So, for this extra credit assignment, please review your health plan member booklet (or find one on the internet).  The member booklet should include a section on appeals.  Use the appeals section to answer the questions below. 

1. How do you request an internal appeal?

2. How long do you have to request an internal appeal after receiving a denial?

3. How does your health plan define “medically urgent” for expedited reviews?

4. How long does an appeal decision take?

5. How can you request an external appeal?

Please number your answers.

Assignment #7: MedPAC June 2023 Report on Medicare

For this week, students will review a chapter of the June 2023 MedPAC Report to Congress on Medicare.  MedPAC stands for the Medicare Payment Advisory Commission and is an independent congressional agency to advise Congress on issues affecting Medicare.  (I encourage you to complete this week's lecture before beginning this assignment.)

1. Select one of the report's chapter summary sections below from chapters 1, 3, 5, 6, or 7 that you will read for your assignment.  

2. Read the report chapter selection  here.Links to an external site. Links to an external site.

3. Write 3 bullets of 3 different things you learned in your reading.  Do not base your response on the Executive Summary at the beginning of the document. 

· Please include a header that tells the reader what option you selected, such as " Chapter 1:  Addressing High Prices of Drugs Covered Under Medicare Part B"

4. Respond to posts from 2 classmates.

Chapters from which to choose:

· Chapter 1:  Addressing High Prices of Drugs Covered Under Medicare Part B (pages 29-34 of the PDF file) 

· Chapter 3:  Standardized Benefits in Medicare Advantage Plans (pages 135-137 of the PDF file) 

· Chapter 5: Disparities in Outcomes for Medicare Beneficiaries with Different Social Risks (pages 229-231 of the PDF file)

· Chapter 6:  Congressional Request: Behavioral Health Services in the Medicare Program (pages 253-256 of the PDF file)

· Chapter 7: Telehealth in Medicare (pages 329-334 of the PDF file)

For this extra credit opportunity, answer the following questions (250 words minimum):

1. Write a reflection on your chart audit experience and the issue of legibility. Possible ideas to discuss:  What was the level of difficulty interpreting the chart? Do you have prior experience trying to read handwriting, and if so, do you think this helped? If you currently work in the field, do you work with any handwritten records? How did you approach this chart review? Is legibility important? How important? Why do you think poor handwriting is so prevalent? 

2. What are some potential issues caused by handwritten records? (Optional: Can you find any real-life examples?)

3. What are some possible strategies you could implement to solve a legibility issue? Address either paper, electronic, or both (we cannot assume we will always have technology - we do live in a state that is prone to storms, flooding, and power outages).

Peer response: Respond to a peer's reflection OR an instructor's question, and provide a substantive reply. Simple agreement or praise does not count as substantive, you need to continue the conversation (ask a question, critique, compare views respectfully, etc.). (50 words minimum)

Grading: Posts must meet minimum word count, be in own words, and demonstrate effort. Initial post is worth 5 points. Peer responses are worth 2 points each, max of 5 peer responses. This extra credit opportunity is worth a total of 15 points.