To ensure that every patient has the coverage co

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.