What type of audit would be necessary to determine whether the reimbursement

What type of audit would be necessary to determine

This preview shows page 6 - 8 out of 18 pages.

What type of audit would be necessary to determine whether the reimbursement impact is reached fully by these departments? Healthcare facilities are required to perform monetary reviews to ensure that appropriate administration and coding methods are being followed. University Hospital would benefit from an internal audit. This would ensure that the reimbursement impact is being reached fully. The role of an internal audit is to “evaluate an organization’s risk management, governance and internal control processes and ensure that they are operating effectively” (Marquette, 2018). During an internal audit there are several steps that occur. First, and auditor(s) are given access to accounts payable and receivable. They will then compare and look for any discrepancies. Next, they will assess compliance with policies and procedures within the organization while also ensure that compliance is met on a state, federal, and contractual obligations. The concluded report that will help develop an annual audit plan can be established. Audits help to educate an organization on areas that need improved upon. How could the impact of these departments on pay-for-performance incentives be measured? Healthcare providers were previously reimbursed on a fee-for-service basis. This means that the provider was reimbursed for the services provided to that patient. The pay-for-performance incentive came into play in the 1990’s and aimed to “improve the quality, efficiency, and overall value of health care. These arrangements offer financial incentives to hospitals, physicians, and other health care facilities that carry out and achieve optimal outcomes for patients” (Health
Image of page 6
Final Project 7 Affairs, 2012). Just like there are financial incentives for positive outcomes, there are also penalties for underperformance. The quality measures used in pay-for-performance generally fall into four categories which include process, outcome, patient experience, and structure. Process measures assess the activities that lead positive health outcomes for patients. Outcome measures refer to the effects that care had on patients. For example, do lab results indicate that a diabetic patients blood sugars are in a controlled range? The patient experience measures the patient’s satisfaction with the level of care they received and how well their overall experience was while in the facility. And finally, structure measures relate to the facilities, personnel, and equipment involved in the treatment of the patient (Health Affairs, 2012). B. Assess the activities within each department at this healthcare organization for how they may impact reimbursement. The departments that have impact on reimbursement are clinical services, billing department, health information management, and administration. Clinical services could also be known as patient registration. This is where the initial point of reimbursement occurs. Patient information in collected, updated, and insurance is verified. All these things help ensure that services rendered are billed to the correct patient. Clinical documentation also provides things
Image of page 7
Image of page 8

You've reached the end of your free preview.

Want to read all 18 pages?

  • Winter '14
  • Health care provider

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture