Does not recommend reimbursement strategies
The final project for this course is the creation of a payment system and reimbursement method analysis and a report to management.
The healthcare industry is impacted by government payer types as administrators prepare strategies and implement internal procedures designed to maximize reimbursement. You are reminded that the primary focal point between healthcare firms and other business operations is the payment method. Healthcare administrators implement strategies designed to meet key performance payment requirements critical for government compliance and reimbursement guidelines. One way administrators accomplish this is to analyze deficiency errors based on quality measures performed by providers, nursing staff, and front desk operations. The Affordable Care Act and other changes in legislation are of continual concern for healthcare organizations as administrators review changes to ensure organizational processes and internal policies are implemented.
Your final project for this course is an analysis with recommendations. The project will require you to prepare an analysis of payment systems and reimbursement methods. You will compare and contrast your findings and offer subsequent recommendations. You will consider compliance and government regulations along with financial principles associated with reimbursement. You will also identify collaborative teamwork strategies that can be incorporated into various healthcare settings.
The project is divided into three milestones, which will be submitted at various points throughout the course to scaffold learning and ensure quality final submissions. These milestones will be submitted in Modules Three, Five, and Seven. The final submission is due in Module Nine.
In this assignment, you will demonstrate your mastery of the following course outcomes:
Assess the extent to which healthcare organizations utilize financial management principles for guiding strategic planning Analyze federal, state, and third-party payer regulations and reporting guidelines for ensuring compliance with healthcare reimbursement requirements Recommend collaborative teamwork principles for improving strategic planning processes involving healthcare reimbursement Suggest financial approaches for improving cash flow, days in accounts receivable, and timeliness of reimbursements from various healthcare payer models Recommend strategies for maximizing healthcare reimbursement by reviewing the impact of case rates and management utilization data on pay-forperformance incentives
Prompt Your analysis with recommendations should answer the following big-picture questions: What reimbursement payment methods and strategies are associated with the healthcare industry? How do financial management principles relate to reimbursement in evaluating operational performance? And, how does the revenue cycle affect various departments within the healthcare organization?
Specifically, the following critical elements must be addressed:
I. Introduction: What is the purpose, scope, and subject of your analysis and management report? Your introduction must describe the aim of your paper, what you are assessing, and the analysis you expect to perform.
II. Financial Principles and Reimbursement: a) Reimbursement Strategies: What is the impact of case rates and management utilization data on pay-for-performance incentives? Be sure to provide support for your response. b) Reimbursement Methods: Analyze reimbursement methods, describing the advantages and disadvantages of each method in terms of strategic planning for operational performance. For example, why might one method be more advantageous than another at a hospital or at a physician’s office? 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. 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? e) Teamwork Principles: Compare and contrast collaborative teamwork principles to most effectively develop strategic planning that involves crossdisciplinary teams. In other words, what principles work best for teams where individuals are from both clinical and non-clinical departments? What are some of the challenges this might present for cohesive collaboration? Be sure to provide support for your response. f) Maximizing Reimbursement: Generally speaking, to what extent do you feel healthcare organizations utilize case rates and management utilization to maximize reimbursement from both government and third-party payer payment systems? Be sure to provide support for your response.
III. Federal and State Payment Systems: a) Federal and State Regulations: Considering the recent changes in economic policy at the federal and state levels, what changes in federal and state regulations present the most concern for healthcare leaders? Be sure to provide support for your response. b) Reporting Requirements: Analyze the reporting guidelines required by Medicaid and Medicare and other government payment systems. What are the opportunities and challenges for healthcare leaders in meeting reporting requirements? c) Compliance Standards and Financial Principles: Analyze how healthcare organizations in general utilize financial principles to ensure compliance with government standards. d) Government Payer Types: Considering Medicaid, Medicare, and other government payer systems, what strategies would you recommend organizations implement in order to receive full reimbursement on claims as well as to improve timeliness of this reimbursement? Be sure to justify your recommendations.
IV. Third-Party Payment Systems: a) Healthcare System Reimbursement: Evaluate third-party payer models for the impacts they present on healthcare system reimbursement.
b) Reporting Requirements: Analyze the reporting guidelines of third-party payer payment systems. What opportunities and challenges do they present for healthcare leaders in meeting reporting requirements? c) Compliance Standards and Financial Principles: Analyze how healthcare organizations in general utilize financial principles to guide strategic planning to ensure the meeting of third-party submission requirements. d) Reimbursement Methods: Considering third-party payer systems, what strategies would you recommend organizations implement in order to receive full reimbursement on claims as well as to improve timeliness of this reimbursement? Be sure to justify your recommendations.
V. Operational and Strategic Planning in Healthcare: a) Pay-For-Performance Incentives: Based on your prior analysis of the impact of case rates and management utilization data on pay-for-performance incentives, recommend appropriate operational strategies to improve performance measures that will maximize reimbursement. Be sure to provide support for your recommendations b) Operational Performance Measures: Considering benchmarking data, recommend performance measures that should be monitored for the purpose of maximizing reimbursement. c) Teamwork and Strategic Planning: Recommend collaborative teamwork principles that would be beneficial for healthcare strategic planning in terms of reimbursement. Be sure to provide support for your recommendations. d) Communicating Strategic Planning Across Teams: What types of tools or strategies would you recommend for communicating strategic planning conclusions to key stakeholders, members of cross-disciplinary teams, and the rest of the organization? In other words, how would you communicate strategic planning information to clinical vs. non-clinical staff? To administrative staff? Be sure to provide support for your recommendations. e) Financial and Reimbursement Strategies: Considering cash flow and days in accounts receivable of hospital and health systems, recommend reimbursement strategies that would be appropriate for low- and high-performing health systems. Provide evidence to support your conclusion.
Milestones
Milestone One: Draft of Financial Principles In Module Three, you will submit a 2–3-page draft of the Financial Principles and Reimbursement portion of your research and analysis. This milestone will be graded with the Milestone One Rubric.
Milestone Two: Draft of Federal and State Payment Systems In Module Five, you will submit a 2–3-page draft of the Federal and State Payment Systems portion of your research and analysis. This milestone will be graded with the Milestone Two Rubric.
Milestone Three: Draft of Third-Party Payment Systems and Planning in Healthcare In Module Seven, you will submit a 2–3-page draft of the Third-Party Payment Systems and the Operational and Strategic Planning in Healthcare portions of your research and analysis. Submit both sections together as a single document. This milestone will be graded with the Milestone Three Rubric.
Final Submission: Analysis and Report In Module Nine, you will submit your analysis and report in its final form addressing all critical elements in this document. In addition to applying the feedback you have received on each section throughout the term, you will develop your introduction for your final submission of the analysis and report. This submission will be graded with the Final Project Rubric.
Deliverables
Milestone Deliverable Module Due Grading One Draft of Financial Principles Three Graded separately; Milestone One Rubric Two Draft of Federal and State Payment Systems Five Graded separately; Milestone Two Rubric Three Draft of Third-Party Payment Systems and Planning in Healthcare Seven Graded separately; Milestone Three Rubric Final Submission: Analysis and Report Nine Graded separately; Final Project Rubric
Final Project Rubric Guidelines for Submission: Your payment system and reimbursement method analysis with report to management should be 10 to 12 pages in length and should be double-spaced in 12-point Times New Roman font with one-inch margins. All citations and references should be formatted according to current APA guidelines. Include at least five references.
Critical Elements Exemplary (100%) Proficient (90%) Needs Improvement (70%) Not Evident (0%) Value Introduction Meets “Proficient” criteria and utilizes industry-specific language to establish expertise and clearly articulate purpose, scope, and subject Comprehensively introduces purpose, scope, and subject of analysis and report Introduces purpose, scope, and subject of analysis and report but with gaps in detail Does not introduce purpose, scope, and subject of analysis and report 3 Financial Principles and Reimbursement: Strategies
Meets “Proficient” criteria and demonstrates exceptional insight into the impact of case rates and management utilization data on reimbursement Logically assesses the impact of case rates and management utilization data on pay-forperformance incentives, supporting response Assesses the impact of case rates and management utilization data on pay-forperformance incentives, supporting response, but with gaps in logic, detail, or relevant support Does not assess the impact of case rates and management utilization data on pay-forperformance incentives 6.27 Financial Principles and Reimbursement: Methods
Meets “Proficient” criteria and demonstrates advanced knowledge of reimbursement methods with regard to strategic planning Accurately analyzes reimbursement methods, describing the advantages and disadvantages of each method in terms of strategic planning for operational performance Analyzes reimbursement methods, describing the advantages and disadvantages of each method, but with gaps in accuracy, detail, or relevancy to strategic planning for operational performance Does not analyze reimbursement methods, describing the advantages and disadvantages of each method in terms of strategic planning for operational performance 3.76 Financial Principles and Reimbursement: Management
Meets “Proficient” criteria and demonstrates exceptional insight into the use of financial management principles for evaluating operational performance Accurately compares and contrasts financial management principles used to evaluate operational performance Compares and contrasts financial management principles used to evaluate operational performance but with gaps in accuracy, relevancy, or detail Does not compare and contrast financial management principles used to evaluate operational performance 3.76 Financial Principles and Reimbursement: Receivable
Meets “Proficient” criteria and draws nuanced connections between cash flow, days in accounts receivable, and reimbursement Logically assesses the challenges associated with collecting payments and explains the significance of monitoring cash flow and days in accounts receivable in terms of reimbursement Assesses the challenges associated with collecting payments and explains the significance of monitoring cash flow and days in accounts receivable, but response has gaps in logic or detail or is irrelevant to reimbursement Does not assess the challenges associated with collecting payments, and does not explain the significance of monitoring cash flow and days in accounts receivable 3.76
Financial Principles and Reimbursement: Teamwork
Meets “Proficient” criteria and demonstrates advanced insight into using teamwork principles for developing strategic plans
Logically compares and contrasts collaborative teamwork principles for most effectively developing strategic planning that involves crossdisciplinary teams, supporting response
Compares and contrasts collaborative teamwork principles for most effectively developing strategic planning that involves cross-disciplinary teams, supporting response, but with gaps in logic, detail, or relevant support
Does not compare and contrast collaborative teamwork principles for developing strategic planning that involves cross-disciplinary teams
6.27
Financial Principles and Reimbursement: Maximizing
Meets “Proficient” criteria and demonstrates exceptional insight into the use of case rates and management utilization data to maximize reimbursement
Logically assesses the extent to which healthcare organizations utilize case rates and management utilization data to maximize reimbursement from both government and thirdparty payer payment systems, supporting response
Assesses the extent to which healthcare organizations utilize case rates and management utilization data to maximize reimbursement from both government and third-party payer payment systems, supporting response, but with gaps in logic, detail, or relevant support
Does not assess the extent to which healthcare organizations utilize case rates and management utilization data to maximize reimbursement from both government and thirdparty payer payment systems
6.27
Federal and State: Regulations
Meets “Proficient” criteria and demonstrates superior insight into the impact of changes in federal and state regulations on healthcare providers
Logically assesses the changes in federal and state regulations that present the most concern for healthcare leaders, supporting response
Assesses the changes in federal and state regulations that present the most concern for healthcare leaders, supporting response, but with gaps in logic, detail, or relevant support
Does not assess the changes in federal and state regulations that present the most concern for healthcare leaders
6.27
Federal and State: Reporting Requirements
Meets “Proficient” criteria and demonstrates advanced knowledge of government payment systems’ reporting guidelines and requirements
Accurately analyzes reporting guidelines required by government payment systems for the opportunities and challenges facing healthcare leaders in meeting reporting requirements
Analyzes reporting guidelines required by government payment systems for the opportunities and challenges facing healthcare leaders in meeting reporting requirements but with gaps in accuracy or detail
Does not analyze reporting guidelines required by government payment systems for the opportunities and challenges facing healthcare leaders in meeting reporting requirements
6.27
Federal and State: Compliance Standards
Meets “Proficient” criteria and demonstrates keen insight into the use of financial principles for ensuring compliance with government standards
Accurately analyzes how healthcare organizations utilize financial principles for ensuring compliance with government standards
Analyzes how healthcare organizations utilize financial principles for ensuring compliance with government standards but with gaps in accuracy or detail
Does not analyze how healthcare organizations utilize financial principles for ensuring compliance with government standards
3.76
Federal and State: Government Payer Types
Meets “Proficient” criteria and recommended strategies are exceptionally relevant and appropriate for the intended purpose
Recommends appropriate strategies for organizations to receive full reimbursement on claims and improve timeliness of reimbursement from government payers, justifying recommendations
Recommends strategies, but they are not appropriate for organizations to receive full reimbursement on claims and improve timeliness of reimbursement from government payers or response has gaps in detail or relevant justification
Does not recommend strategies for organizations to receive full reimbursement on claims and improve timeliness of reimbursement from government payers
3.76
Third-Party Payment: Reimbursement
Meets “Proficient” criteria and draws nuanced connections between third-party payer models and reimbursement
Accurately evaluates thirdparty payer models for the impact they present on healthcare system reimbursement
Evaluates third-party payer models for the impact they present on healthcare system reimbursement but with gaps in accuracy or detail
Does not evaluate third-party payer models for the impact they present on healthcare system reimbursement
3.76
Third-Party Payment: Reporting Requirements
Meets “Proficient” criteria and demonstrates advanced knowledge of third-party payer payment systems’ reporting guidelines and requirements
Accurately analyzes reporting guidelines required by thirdparty payer payment systems for the opportunities and challenges facing healthcare leaders in meeting reporting requirements
Analyzes reporting guidelines required by third-party payer payment systems for the opportunities and challenges facing healthcare leaders in meeting reporting requirements but with gaps in accuracy or detail
Does not analyze reporting guidelines required by thirdparty payer payment systems for the opportunities and challenges facing healthcare leaders in meeting reporting requirements
6.26
Third-Party Payment: Compliance Standards
Meets “Proficient” criteria and demonstrates keen insight into the use of financial principles for ensuring compliance with third-party payer submission requirements
Accurately analyzes how healthcare organizations utilize financial principles for guiding strategic planning in ensuring compliance with third-party payer submission requirements
Analyzes how healthcare organizations utilize financial principles for guiding strategic planning in ensuring compliance with third-party payer submission requirements but with gaps in accuracy or detail
Does not analyze how healthcare organizations utilize financial principles for guiding strategic planning in ensuring compliance with third-party payer submission requirements
3.76
Third-Party Payment: Reimbursement Methods
Meets “Proficient” criteria and recommended strategies are exceptionally relevant and appropriate for the intended purpose
Recommends appropriate strategies for organizations to receive full reimbursement on claims and improve timeliness of reimbursement from thirdparty payer systems, justifying recommendations
Recommends strategies, but they are not appropriate for organizations to receive full reimbursement on claims and improve timeliness of reimbursement from thirdparty payer systems or response has gaps in detail or relevant justification
Does not recommend strategies for organizations to receive full reimbursement on claims and improve timeliness of reimbursement from thirdparty payer systems
3.76
Planning: Pay-forPerformance
Meets “Proficient” criteria and demonstrates exceptional insight into the use of improving performance measures to maximize reimbursement
Makes appropriate recommendations for operational strategies to improve performance measures that will maximize reimbursement based on prior analysis of impact of case rates and management utilization data, providing support for recommendations
Makes recommendations, but they are not appropriate for operational strategies to improve performance measures that will maximize reimbursement, recommendations are not based on prior analysis of impact of case rates and management utilization data, or response has gaps in detail or relevant support
Does not make recommendations for operational strategies to improve performance measures that will maximize reimbursement
6.26
Planning: Operational Performance
Meets “Proficient” criteria and demonstrates exceptional insight into the use of benchmarking for maximizing reimbursement through improved operational performance
Recommends appropriate performance measures that should be monitored for the purpose of maximizing reimbursement, considering benchmarking data
Recommends performance measures that should be monitored for the purpose of maximizing reimbursement, but measures are not appropriate for the intended purpose or recommendations are not based on benchmarking data
Does not recommend performance measures that should be monitored for the purpose of maximizing reimbursement, considering benchmarking data
3.76
Planning: Teamwork
Meets “Proficient” criteria and demonstrates advanced insight into using teamwork principles for developing strategic plans surrounding reimbursement
Recommends appropriate collaborative teamwork principles that would be beneficial for healthcare strategic planning in terms of reimbursement, providing support for recommendations
Recommends teamwork principles, but they are not appropriate or adequate for the intended purpose or response has gaps in detail or relevant support
Does not recommend collaborative teamwork principles that would be beneficial for healthcare strategic planning in terms of reimbursement
6.27
Planning: Communicating
Meets “Proficient” criteria and demonstrates exceptional insight into communication tools and strategies for targeted audiences
Recommends appropriate tools or strategies for communicating strategic planning conclusions to various audiences, providing support for recommendations
Recommends tools or strategies, but they are not appropriate for communicating strategic planning conclusions to various audiences or response has gaps in detail or relevant support
Does not recommend tools or strategies for communicating strategic planning conclusions to various audiences
6.26
Planning: Financial and Reimbursement Strategies
Meets “Proficient” criteria and recommended strategies are exceptionally relevant and wellsuited for the intended purpose
Recommends appropriate reimbursement strategies for low- and high-performing health systems, considering cash flow and days in accounts receivable, supporting conclusion with evidence
Recommends strategies for low- and high-performing health systems, but recommendations are not appropriate for the intended purpose or do not consider cash flow and days in accounts receivable, or response has gaps in detail or relevant support
Does not recommend reimbursement strategies for low- and high-performing health systems
3.76
Articulation of Response
Submission is free of errors related to citations, grammar, spelling, syntax, and organization and is presented in a professional and easy-to-read format
Submission has no major errors related to citations, grammar, spelling, syntax, or organization
Submission has major errors related to citations, grammar, spelling, syntax, or organization that negatively impact readability and articulation of main ideas
Submission has critical errors related to citations, grammar, spelling, syntax, or organization that prevent understanding of ideas
3
Total
Collepals.com Plagiarism Free Papers
Are you looking for custom essay writing service or even dissertation writing services? Just request for our write my paper service, and we'll match you with the best essay writer in your subject! With an exceptional team of professional academic experts in a wide range of subjects, we can guarantee you an unrivaled quality of custom-written papers.
Why Hire Collepals.com writers to do your paper?
Quality- We are experienced and have access to ample research materials.
We write plagiarism Free Content
Confidential- We never share or sell your personal information to third parties.
Support-Chat with us today! We are always waiting to answer all your questions.