Payment System and Reimbursement Method Analysis.docx - RUNNING HEAD ANALYSIS AND REPORT1 Analysis and Report December 2 2018 ANALYSIS AND REPORT 2

Payment System and Reimbursement Method Analysis.docx -...

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RUNNING HEAD: ANALYSIS AND REPORT1 Analysis and Report December 2, 2018
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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
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ANALYSIS AND REPORT 3 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).
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