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AccountsReceivableIn all healthcare settings, accounts receivable manages payments due from the customer or third-party payers (Casto & Forrestal, 2015). The challenges collecting payments in accounts receivable relate to older accounts due for payments and remittance advice (RA) that remains outstanding. The RA’s include claim rejections, denials and payments that need an analysis for resubmission to the third-party payer. Marting (2015), reports that claim denials are the result of timely filing, invalid subscriber identifiers, non-covered services, bundled services, incorrect use of modifiers, and data discrepancies. Accounts receivable and collections manage payments billed to the patient in co-payments and deductibles, which may result in accounts being sent to the collections department. Monitoring cash flow and number of days in accounts receivable is significant due to accounts that remain outstanding and unpaid the facility is less likely to receivepayments (Casto & Forrestal, 2015). Teamwork Principles
FINANCIAL PRINCIPLES7Integrating collaborative teamwork principles into an effective strategic plan across disciplinary teams within clinical and non-clinical departments is significant to operational reimbursement success. Use of the TeamStepps principals promotes team work by utilizing tools and strategies that “increase a team’s awareness through a shared model” (Ferguson, 2008). The model integrates healthcare professionals across departments by use of a framework that integrates principles, skills, and core competencies (Ferguson, 2008). The training system utilizeskey components of performance assessments of attitudes and knowledge by the leadership team, monitoring of the situation, mutual support, and communication. The challenges with TeamStepps include changing culture and sustainability in any healthcare setting within clinical and non-clinical areas (Ferguson, 2008).This model can be utilized across non-clinical departments in relation to components of patient care, billing, coding and need for clear documentation and coding. The communication between clinical and non-clinical employees’ collaboration will strengthen financial reimbursement to achieve operational efficiency. Maximizing ReimbursementHealth care organizations can utilize case rate and management utilization to maximize reimbursement throughout all payer systems by ensuring that coding and documentation reflects the acuity of the patient. To maximize episodic reimbursement, utilization of services includes the management of cost-effective care which will limit the number of services provided with a decrease in covered supplies. A program that utilizes the bundled payment through Medicare services can maximize reimbursement by combining payments across health care settings (Casto & Forrestal, 2015). Thebundled program that is currently utilized in the hospital and home health includes the “Bundled Joint Program”. During the episode of care the patient is admitted for Total Knee Arthroplasty with a one-night acute care hospital stay, transitioned to home health with limited number of visits for a total of two