Secondly the provider has to be comfortable with

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Secondly, the provider has to be comfortable with methods used in medical records documentation. Thirdly, the physicians have to capture all the services and procedures provided to the patients in the charge capture form. Fourthly, the physicians have to ensure there is coding or verification of the appropriate diagnoses, procedures, and services. The fifth guideline is to make a charge entry which has to be completed promptly to ensure claims transmission (Chaudhry et al., 2016).The following guidelines are critical to ensuring healthcare practitioners receive payment without delays. Besides, following the guidelines will help in eliminating cases of malpractices and dishonesty. However, physicians encounter problems in following the guidelines due to lack of knowledge on how some insurers reimburse payments (Lieberthal, 2016). Also, dealing with much paperwork will decrease the amount of time the physician deals with patients; therefore, it is critical that not only the physican but all staff members are well-educated in the billing process(Casto & Forrestal, 2015).Compliance Standards and Financial PrinciplesHealthcare organizations ensure compliance by making a sufficient documentation detailing the services provided to every patient. The physicians have to showcase whether the patient actually needed medical services that commensurate with the claims (Niles, 2016). Also, the compliance standards dictate that there should exist a correct coding process that captures
PAYMENT SYSTEM ANALYSIS11detailed information. The payments claims must be proportionate to the services rendered by the provider to seal loopholes used by some providers to hike the costs of health services to fraud theinsurer.Reimbursement MethodsThe primary care capitation is the best model for any typical healthcare organization. The method allows the insurer to make a fixed payment to the provider for a particular set of services irrespective of quantity provision. The strength of the model is that it places the “performance risk” on physicians through the provision of financial incentives that limit provision of unnecessary services (Casto & Forrestal, 2015). In order to receive full reimbursement on claims, as well as to improve timeliness of reimbursement, organizations should implement strategies that include frequent monitoring, auditing, and education of all staff.It falls upon providers to document procedures and treatment clearly, on medical assistants and front end to properly document demographics, and for back-end staff to appropriately and timely submit claims to a second reviewer prior to submitting for reimbursement (Niles, 2016).Operational and Strategic Planning in HealthcarePay-For-Performance IncentivesA healthcare organization has to increase the quality of services given to the consumers.

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