likely; and savings that arise because no additional payments will be made for the cost of treating complications (NSCL, 2010). In other words, employees should have a reimbursement plan. c) Financial Management Principles: Compare and contrast financial management principles such as financial data that describe financial performance of revenue reimbursement, benchmarking of industry standards, payer-mix breakdown of payers, and case rate and utilization rate data used to evaluate operational performance. Financial management is a process of planning, organizing, controlling and monitoring financial resources with a view to achieve organizational goals and objectives. It is a practice for controlling
financial activities of an organization such as procurement of funds, utilization of funds, accounting, payments, risk assessment, etc. If finances are not properly handled, the organization might face barriers that could have repercussions on its growth and development (FundsforNGOs, 2018). Dealing with different health insurance providers can be complicated due to the registration and compliance department to ensure they are managing patients correctly. Benchmarking is the process of establishing a standard of excellence and comparing a business function of activity, a product, or an enterprise that will be used to reduce expenses and improve quality (Benson, 1994). It is a continuous process to measure and compare its own processes to others in a certain area to improve their practice. The payer mix report is generated to find a breakdown of the number of claims, total charges and payments, and total adjustments by financial class or payer. It can be broken down by provider and location. It provides an average amount of charges, payments, and adjustments for each financial class/payer, and percentage of them. d) Accounts Receivable: What are the challenges associated with collecting payments for the accounts receivable or collections department, and what is the significance of monitoring cash flow and days in accounts receivable in terms of reimbursement? Accounts receivable is the outstanding invoices the organization has or the money that is owed from its client. In other words, they have performed their services and but haven’t received their money yet. When invoicing the patient, a document is providing outlining the products and services that were rendered and the date the payment is due. The longer a company takes to send an invoice, the longer it takes for the patient to make patients. This is important why an invoice must be sent promptly (King, 2018). Denied insurance claims can make healthcare firms lose about 10% in potential profits if their denial management process is inadequate. Before providing services, the organization must have all the necessary billing and insurance information before providing the service and calculate the expected cost they need to pay out of pocket (Roger, 2017). When you provide services, you expect to get paid.
- Fall '19