RUNNING HEAD: ANALYSIS AND REPORT1
Analysis and Report
December 2, 2018
ANALYSIS AND REPORT
2
Analysis and Report
Introduction
As a hospital administrator, my responsibility is to propose the significance of medical
reimbursements in the healthcare organization, which brings stability to the financial state of the
organization. There are numerous operational implementations that the organization can manage.
Also, all revenue influences the whole hospital particularly our patients as it's their healthcare
benefits that cover their healthcare cost. Our organization is presently in the process of
reassessing its revenue cycle which I am currently going over. In this assessment, we will cover
reimbursement strategies, methods, financial management, accounts receivable, the teamwork
involves in the technique and how to maximize reimbursements. Also, there is a summary of the
federal and state regulation that worries our healthcare leaders, opportunity and challenges for
reporting requirements. This healthcare organization has a department that develops ethics to
warrant acceptance with government standards. To finish, the commendation of the policies that
need to be taken to ensure that our organization receives full reimbursement on claims to provide
the forthcoming of our organization.
Financial Principles and Reimbursement
Strategies
A pay-for-performance or value-based buying (P4P) design consists of financial incentives or
penalties based on a provider’s ability or inability to meet specific performance expectations
based on predetermined measures (Belogolovsky & Bamberger, 2014). P4P models measure
performance using a clinical method and consequence measures and surveys on patients’
experiences with care. For instance, Merit-based Incentive Performance System (MIPS) is a
prominent P4P which consists of means of “meaningful use” of electronic health records and
resource use. Often implemented as a performance-based bonus on top of usual payment
ANALYSIS AND REPORT
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methods, P4P as adopted in Medicare also includes disciplines with considerable financial
impact (Centers for Medicare & Medicaid Services, 2018). The capacity of case rates
immediately affects the pay for performance incentive. The more thriving the cases are there will
be an increase in payment as the number of patients increase via the positive feedback. The
utilization management efforts immediately interest the healthcare patients excluding the
occasions when the provider directly allocate the financial risk associated with the services. The
case rates and management usage have to be suitably taken into thought to lessen the hazards.
Methods
There are two types of reimbursement methods in the healthcare industry which consist
of the fee-for-service. This method that has been used in which physicians and other healthcare
providers are paid for each service performed such as test or office visits (Rajpal et al., 2013).
