Question

Investigate the definition of and the purpose of a Medicare Fiscal Intermediary (FIs) and prepare an initial post that answers the following questions:

•    What is the purpose of FIs?
• Do you think the U.S. government is being fiscally responsible with this type of payment process through a third party?
•    Do you suggest an alternative payment process?

Answer 1

A fiscal Intermediary (FI) refers to an entity or a private company that has a contract with the center for medicare and medicaid services (CMS) to determine and to pay part A and some part B bills such as bills from hospitals, on a cost basis and to perform other related functions. They are also called an "intermediary". The decision made by an FI or a carrier under medicare part A or part B is called the local coverage determination (LCD).

The Medicare fiscal intermediaries (FIs) are private insurance companies that serve as the federal government's agents in the administration of the Medicare program, including the payment of claims. There are two primary functions for the FI--reimbursement review and medical coverage review. Hospital-based home health agencies relate to the hospital's FI for reimbursement purposes. All home health agencies are assigned to a special FI, the Regional Home Health Intermediary (RHHI), for medical review issues. The same or a different FI may audit the hospital's cost report. Freestanding home health agencies deal with separate reimbursement and medical review divisions within a single RHHI's office.

                    financial institution relies upon third parties to provide operational services, they also rely on those service providers to have sufficient recovery capabilities for the specific services they perform on behalf of the financial institution. In addition to providing systems and processing, technology service providers (TSPs) may also be retained by a financial institution to provide information technology (IT) recovery capabilities for the financial institution’s internal systems. Effective business continuity planning (BCP) and testing demonstrate the financial institution’s ability not only to recover IT systems, but also to return critical business functions to normal operationswithin established recovery time objectives (RTOs). A financial institution should be able to demonstrate the ability to recover critical IT systems and resume normal business operations regardless of whether the process is supported in-house or at a TSP for all types of adverse events (e.g., natural disaster, infrastructure failure, technology failure.