Financial Principles and Reimbursement.docx - FINANCIAL...

FINANCIAL PRINCIPLES AND REIMBURSEMENT 1
Financial Principles and Reimbursement
Ashlee Thompson
January 9, 2018

FINANCIAL PRINCIPLES AND REIMBURSEMENT 2
While working as an administrator in healthcare, it is important to know how to utilize
the revenue cycle management program and ensure the organization is thriving. The job duties
include the organization is making sure the organization’s costs stay low and have a flow of
reimbursement coming in. Compliance issues must be met. Promoting cooperation between each
department is crucial just as it is making sure each of them is up-to-date about trends in
technology and educating them on how to stay informed on the changes in market of payer
trends, government, and regulatory modifications [ CITATION Cas13 \l 1033 ]. The overall goal
is to make sure patient care and readmissions were as low as possible. Offering the patient a
lower-cost option for follow-up care can help maintain loyal clientele.
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.
The Patient Protection and Affordable Care Act (PPACA) was the new law in 2010 that
gave the Administration widespread authority to control every aspect of health care finance and
to impose its view of how the health care system should operate [ CITATION Hof10 \l 1033 ].
The reimbursement strategy in healthcare is a common technique that allows employers to
provide their employees with more choices about healthcare expenditure. The PPACA, also
known as Obamacare, creates new Medicare programs intended to improve health care quality
using “pay-for-performance” payment strategies to put financial pressure on medical providers.
The reimbursement reflects provider performance on metrics based on adherence to certain care
processes, scores on patient satisfaction surveys, and patient outcomes. The rationale behind the
pay for performance is that the payment for medical services does not reflect the benefit for
patients or value [ CITATION Hof10 \l 1033 ].

FINANCIAL PRINCIPLES AND REIMBURSEMENT 3
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?