visit to capture errors. To ensure that every patient has the coverage, co-payments and deductible amounts are collected, front-end staff need to double check the information that is collected. Software that flags errors in the scheduling process will ensure that all the appropriate information is verified and collected prior to the claim being filed. According to Riley (2010), healthcare organizations should consider “ partnering with a revenue cycle management vendor that can greatly simplify your claims filing processes” because of the complexity of third-party payment systems. 14
Analysis and Management Report Operational and Strategic Planning in Healthcare Operational and strategic planning in healthcare will ensure that claims are submitted according to laws, regulations and third-party payer guidelines to ensure proper reimbursements. Reimbursement is exceptionally important to healthcare organizations as this is the main source of revenue. Healthcare administrators must provide all medical staff with the reporting requirements, compliance standards and reimbursement methods for third-party payment systems so that every precaution can be taken to decrease denials. Pay-for-performance incentives help to ensure that providers are not ordering and providing unnecessary services which can drive up denial rates. Pay-For-Performance Incentives In the pay-for-performance model, providers are reimbursed based on efficiency metrics that outline quality care and cost-saving methods. Healthcare administrators face challenges implementing pay-for-performance incentives due to the different meanings of quality within an organization. Getting healthcare staff to agree on what quality standards should be focused on can be challenging. According to Hughes (2008), “quality improvement is the belief that good performance reflects good-quality practice, and that comparing performance among providers and organizations will encourage better performance.” One method a healthcare organization can utilize when seeking to improvement performance through appropriate operational strategies is the Plan-Do-Study-Act (PDSA) model. This model will allow administrators to focus on criteria need to improve issues that may be affecting the revenue cycle. By focusing on the healthcare metrics, administrators can observe statics on readmission, diagnostics testing, quality and reimbursement through the pay-for-performance model. 15
Analysis and Management Report Operational Performance Measures Healthcare administrators use benchmarking data to compare the organizations current operational practices with a standard to help achieve goals and strategic planning while providing patients with the highest quality of care. The data obtained through benchmarking allow healthcare administrators to set quality improvement plans (QI) to better motivate and engage medical staff to improvement their standard practices. There are a number of performance measures that should be monitored for the purpose of maximizing reimbursement.
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- Fall '19
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