100%(8)8 out of 8 people found this document helpful
This preview shows page 8 - 11 out of 15 pages.
d)Government Payer TypesThere are strategies that I would recommend as the Administrator of our hospital to implement in order to receive full reimbursement on claims. One strategy is to double-check errors and claims through an automation system (Tohill, 2016). Another strategy is on-going training for all billing staff to stay ahead of ongoing changes in the healthcare field. Also better management of denied claims will improve reimbursement. “Most claims are denied due to minor details. Train your staff, your providers and everyone else who impacts billing to completeforms accurately, legibly, and without error” (2016). The billing department will be managed by a daily management system to ensure proper measureable rates. This will also allow for immediate investigation of denials (2016).8
IV. Third-Party Payment Systemsa)Healthcare System ReimbursementThird-party payer models pay for services to the hospital or provider and can include Medicare or health insurance companies (Casto & Forrestal, p. 8). Third-party payer models have various impacts on reimbursement. There are financial risks for all models including determining payment for each service, time orientation, and projected costs (p. 8). “The account receivable department manages the amounts owed to a facility by customers who received services but whose payments will be made at a later date by the patients or their third-party payers” (p. 255). The impact of time is present during this phase of reimbursement. The longer the time frame, the less likely the provider or hospital will get paid (p. 255). Third-party payer systems also impact consumers by raising prices as demands increase.b)Reporting Requirements“Well designed and complete policies and procedures provide employees with consistent guidance to perform their assigned task” (Casto & Forrestal, p. 44). Without reporting guidelines mistakes will happen. When mistakes happen, the hospital or provider may find themselves involved with compliance issues. The opportunities that reporting guidelines present for leaders is lower costs and lower prices for consumers. The threats present for leaders is the fear of reporting the problems as they arise. c)Compliance StandardsIn general, financial principles are utilized to guide strategic planning to ensure submission requirements through highly regulated processes. This is regulated through many different agencies and organizations like the Joint Commission. It is the mission of the Joint Commission to “continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective 9
care of the highest quality and value” (The Joint Commission, 2019). Financial principles include following a strict pay model, preventing malpractice and providing less incentives for doctors. The goal is to focus on quality of care rather than quantity of care.