Describe what reimbursement means to this specific healthcare organization. What would happen if services were provided to patients but no payments were received for these services?

Overview: Much of what happens in healthcare is about understanding the expectations of the many departments and personnel within the organization. Reimbursement drives the financial operations of healthcare organizations; each department affects the reimbursement process regarding timelines and the amount of money put into and taken out of the system. However, if departments do not follow the guidelines put into place or do not capture the necessary information; it can be detrimental to the reimbursement system. An important role for patient financial services (PFS) personnel is to monitor the reimbursement process, analyze the reimbursement process, and suggest changes to help maximize the reimbursement. One way to make this process more efficient is by ensuring that the various departments and personnel are exposed to the necessary knowledge. Section 1:  provides you an opportunity to engage with real-world data and tools that you would encounter in an actual professional environment. Specifically, you will begin thinking about the purpose of reimbursement and how it impacts other healthcare departments. You will also practice analyzing the revenue cycle. Prompt:  Submit a draft of your Section I Specifically, the following critical elements must be addressed:

1. Reimbursement and the Revenue Cycle
2. Describe what reimbursement means to this specific healthcare organization. What would happen if services were provided to patients but no payments were received for these services? What specific data would you review in the reimbursement area to know whether changes were necessary?
3. Illustrate the revenue cycle using a flowchart tool. Take the patient through the cycle from the initial point of contact through the care and ending at the point where the payment is collected.
4. Prioritize the departments at this specific healthcare organization in order of their importance to the revenue cycle. Support your ordering of the departments with evidence.

Section2: Departmental Impact on Reimbursement

1. Describe the impact of the departments at this healthcare organization that utilize reimbursement data. What type of audit would be necessary to determine whether the reimbursement impact is reached fully by these departments? How could the impact of these departments on pay-for-performance incentives be measured?
2. Assess the activities within each department at this healthcare organization for how they may impact reimbursement.
3. Identify the responsible department for ensuring compliance with billing and coding policies. How does this affect the department’s impact on reimbursement at this healthcare organization?

Section 3: The following critical elements must be addressed: III. Billing and Reimbursement

1. Analyze the collection of data by patient access personnel and its importance to the billing and collection process. Be sure to address the importance of exceptional customer service.
2. Analyze how third-party policies would be used when developing billing guidelines for patient financial services (PFS) personnel and administration when determining the payer mix for maximum reimbursement.
3. Organize the key areas of review in order of importance for timeliness and maximization of reimbursement from third-party payers. Explain your rationale on the order.
4. Describe a way to structure your follow-up staff in terms of effectiveness. How can you ensure that this structure will be effective?
5. Develop a plan for periodic review of procedures to ensure compliance. Include explicit steps for this plan and the feasibility of enacting this plan within this organization.
6. Marketing and Reimbursement
7. Analyze the strategies used to negotiate new managed care contracts. Support your analysis with research.
8. Communicate the important role that each individual within this healthcare organization plays with regard to managed care contracts. Be sure to include the different individuals within the healthcare organization.
9. Explain how new managed care contracts impact reimbursement for the healthcare organization. Support your explanation with concrete evidence or research.
10. Discuss the resources needed to ensure billing and coding compliance with regulations and ethical standards. What would happen if these resources were not obtained? Describe the consequences of noncompliance with regulations and ethical standards.

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ANSWER. PAPER DETAILS
Academic Level	Masters
Subject Area	Nursing
Paper TypeÂ	Research Paper
Number of Pages	5 Page(s)/1375 words
Sources	2
Paper Format	APA
Spacing	Double Spaced

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