The final project for this course is the creation of a payment system and reimbursement method analysis and a report to management.
The healthcare industry is impacted by government payer types as administrators prepare strategies and implement internal procedures designed to maximize reimbursement. You are reminded that the primary focal point between healthcare firms and other business operations is the payment method. Healthcare administrators implement strategies designed to meet key performance payment requirements critical for government compliance and reimbursement guidelines. One way administrators accomplish this is to analyze deficiency errors based on quality measures performed by providers, nursing staff, and front desk operations. The Affordable Care Act and other changes in legislation are of continual concern for healthcare organizations as administrators review changes to ensure organizational processes and internal policies are implemented.
Your final project for this course is an analysis with recommendations. The project will require you to prepare an analysis of payment systems and reimbursement methods. You will compare and contrast your findings and offer subsequent recommendations. You will consider compliance and government regulations along with financial principles associated with reimbursement. You will also identify collaborative teamwork strategies that can be incorporated into various healthcare settings.
In this assignment, you will demonstrate your mastery of the following course outcomes:
· Assess the extent to which healthcare organizations utilize financial management principles for guiding strategic planning
· Analyze federal, state, and third-party payer regulations and reporting guidelines for ensuring compliance with healthcare reimbursement requirements
· Recommend collaborative teamwork principles for improving strategic planning processes involving healthcare reimbursement
· Suggest financial approaches for improving cash flow, days in accounts receivable, and timeliness of reimbursements from various healthcare payer models
· Recommend strategies for maximizing healthcare reimbursement by reviewing the impact of case rates and management utilization data on pay-for performance incentives
Prompt: Your analysis with recommendations should answer the following big-picture questions: What reimbursement payment methods and strategies are associated with the healthcare industry? How do financial management principles relate to reimbursement in evaluating operational performance? And, how does the revenue cycle affect various departments within the healthcare organization?
Specifically, the following critical elements MUST be addressed:
I. Introduction: What is the purpose, scope, and subject of your analysis and management report? Your introduction must describe the aim of your paper, what you are assessing, and the analysis you expect to perform.
II. Financial Principles and Reimbursement:
a) Reimbursement Strategies: What is the impact of case rates and management utilization data on pay-for-performance incentives? Be sure to provide support for your response.
b) Reimbursement Methods: Analyze reimbursement methods, describing the advantages and disadvantages of each method in terms of strategic planning for operational performance. For example, why might one method be more advantageous than another at a hospital or at a physician’s office?
c) Financial Management Principles: Compare and contrast financial management principles such as financial data that describe financial performance of revenue reimbursement, benchmarking of industry standards, payer-mix breakdown of payers, and case rate and utilization rate data used to evaluate operational performance.
d) Accounts Receivable: What are the challenges associated with collecting payments for the accounts receivable or collections department, and what is the significance of monitoring cash flow and days in accounts receivable in terms of reimbursement?
e) Teamwork Principles: Compare and contrast collaborative teamwork principles to most effectively develop strategic planning that involves cross disciplinary teams. In other words, what principles work best for teams where individuals are from both clinical and non-clinical departments? What are some of the challenges this might present for cohesive collaboration? Be sure to provide support for your response.
f) Maximizing Reimbursement: Generally speaking, to what extent do you feel healthcare organizations utilize case rates and management utilization to maximize reimbursement from both government and third-party payer payment systems? Be sure to provide support for your response.
III. Federal and State Payment Systems:
a) Federal and State Regulations: Considering the recent changes in economic policy at the federal and state levels, what changes in federal and state regulations present the most concern for healthcare leaders? Be sure to provide support for your response.
b) Reporting Requirements: Analyze the reporting guidelines required by Medicaid and Medicare and other government payment systems. What are the opportunities and challenges for healthcare leaders in meeting reporting requirements?
c) Compliance Standards and Financial Principles: Analyze how healthcare organizations in general utilize financial principles to ensure compliance with government standards.
d) Government Payer Types: Considering Medicaid, Medicare, and other government payer systems, what strategies would you recommend organizations implement in order to receive full reimbursement on claims as well as to improve timeliness of this reimbursement? Be sure to justify your recommendations.
IV. Third-Party Payment Systems:
a) Healthcare System Reimbursement: Evaluate third-party payer models for the impacts they present on healthcare system reimbursement.
b) Reporting Requirements: Analyze the reporting guidelines of third-party payer payment systems. What opportunities and challenges do they present for healthcare leaders in meeting reporting requirements?
c) Compliance Standards and Financial Principles: Analyze how healthcare organizations in general utilize financial principles to guide strategic planning to ensure the meeting of third-party submission requirements.
d) Reimbursement Methods: Considering third-party payer systems, what strategies would you recommend organizations implement in order to receive full reimbursement on claims as well as to improve timeliness of this reimbursement? Be sure to justify your recommendations.
V. Operational and Strategic Planning in Healthcare:
a) Pay-For-Performance Incentives: Based on your prior analysis of the impact of case rates and management utilization data on pay-for-performance incentives, recommend appropriate operational strategies to improve performance measures that will maximize reimbursement. Be sure to provide support for your recommendations
b) Operational Performance Measures: Considering benchmarking data, recommend performance measures that should be monitored for the purpose of maximizing reimbursement.
c) Teamwork and Strategic Planning: Recommend collaborative teamwork principles that would be beneficial for healthcare strategic planning in terms of reimbursement. Be sure to provide support for your recommendations.
d) Communicating Strategic Planning Across Teams: What types of tools or strategies would you recommend for communicating strategic planning conclusions to key stakeholders, members of cross-disciplinary teams, and the rest of the organization? In other words, how would you communicate strategic planning information to clinical vs. non-clinical staff? To administrative staff? Be sure to provide support for your recommendations.
e) Financial and Reimbursement Strategies: Considering cash flow and days in accounts receivable of hospital and health systems, recommend reimbursement strategies that would be appropriate for low- and high-performing health systems. Provide evidence to support your conclusion.