HCM 345 Milestone. Draft of Departmental Impact On Reimbursement
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HCM 345 Milestone One Guidelines and Rubric
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 theamount 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 necessaryinformation, 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 suggestchanges to help maximize the reimbursement. One way to make this process more efficient is by ensuring that the various departments and personnel areexposed to the necessary knowledge.Milestone One provides you an opportunity to engage with real-world data that you would encounter in an actual professional environment. Specifically, you willtake a closer look at how reimbursement impacts other healthcare departments, and you will dive deep into analyzing the revenue cycle, utilizing data, trackingrecords, and ensuring compliance within individual departments.Prompt: Submit a draft of Sections I and II of the final project. Specifically, the following critical elements must be addressed:I. Reimbursement and the Revenue Cyclea. Describe what reimbursement means to a healthcare organization. What would happen if services were provided to patients but no paymentswere received for those services?b. Illustrate the flow of the patient through the cycle from the initial point of contact through the care and ending at the point where the paymentis collected. Also identify the departments in order of importance to the revenue cycle.II. Departmental Impact on Reimbursementa. Describe the impact of the departments in a healthcare organization that utilize reimbursement data. What type of audit would be necessary todetermine whether the reimbursement impact is reached fully by these departments? How could the impact of these departments on pay-forperformance incentives be measured?b. Assess the activities within each department in a healthcare organization for how they may impact reimbursement. What specific data wouldyou review in the reimbursement area to know whether changes were necessary?c. Identify the responsible department for ensuring compliance with billing and coding policies. How does this affect the department’s impact onreimbursement in a healthcare organization?
Milestone
Author’s Name
The Institutional Affiliation
Course Number and Name
Instructor Name
Assignment Due Date
Milestone
Reimbursement and Revenue Cycle
* Reimbursement
In most of the company’s payment for a service or an item is very straight forward. The customer makes the payment of the for the services used or the product purchased. The entire process takes a couple of seconds. Whereas, healthcare reimbursement is much convoluted and lengthy process. The significant difference between other industries and healthcare is that they are paid after the services are utilized and rendered by the patients. The process of reimbursement describes the payment made to hospital, doctors or facilities for providing medical services. Insurance companies or government provides the healthcare cover. It depends on the coverage plan one has taken and will be provided with the same at the healthcare. Reimbursement depends on the coverage plan taken from the insurance company, and payment has to be made accordingly to health care.
If any of step with go wrong from, there will be a delay in payments to the healthcare, and due to long delays, patients will be confused with the bills. There are chances they will refuse to pay the bill. The Affordable Care Act (ACA) showed high intentions to control and lower the healthcare costs by distributing the risk among healthy and unhealthy people (Fifer, 2016). When the organization does not recover reimbursement for the services provided, then it takes the healthcare towards loses. The management will not be paid well; no restocking of supplies and treatment of the patients will be neglected.
* Patient’s Revenue Cycle
The flow of patients and revenue cycle of the healthcare; Patient registration/demographics entry: the front desk will take patients data and maintain record into the system of the organization. Insurance Verification: Front-desk will enter the details of the patient in the system, which includes an insurance company’s name and coverage. Medical Transcription: front-desk will direct the patient to the respective doctor’s facility. Patient’s data will automatically send to the doctors’ facility. Medical coding: doctor and patients discussion will be recorded by the doctor, along with the medical history prescribed treatment. Medical Billing: the bill will be generated after the treatment and consultation, which will automatically go to the accounts and finance system along with the patient’s details. Claims Generation: The accounts receivable department will send the invoicing details to the respective insurance company and will claim the amount. Follow-ups: Accounts receivable will take the regular follow-ups from the insurance company and an expected date for receiving the payment. Payment posting: Once the payment will be received; then the entry will be posted of cash/cheque received from the trade receivables (Patient’s Insurance Company). Revenue: The department will post revenue recognition. Patient Follow-up: If suggested by the doctor, then the patient will be called for a follow-up session or treatment.
* Departmental Impact on Reimbursement
* Impact of Department
Healthcare organizations come under non-profit organizations; they have multiple facilities like emergencies, children healthcare, gynaecology and more. The revenue is booked under...
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