3rd Party Payment Systems & Operational & Strategic Planning Paper

/in /by

I need an explanation for this Health & Medical question to help me study.

 

Overview: Hospital administrators review accounts receivable schedules and reports to determine how much revenue is being received from various sources (i.e., Medicaid, Medicare, Anthem, self-pay from patients, and other third-party payers). Revenue from various sources is referred to as the organization’s “payer mix.” In this milestone, you will examine operational and strategic planning in healthcare and consider selecting the three elements that you feel will be most important to complete in terms of receiving feedback.

Prompt: Submit a draft of the Third-Party Payment Systems and the Operational and Strategic Planning in Healthcare portions of your research and analysis. Specifically, the following critical elements must be addressed:

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 for hospital and health systems, recommend reimbursement strategies that would be appropriate for low- and high-performing health systems. Provide evidence to support your conclusion.

Rubric

Guidelines for Submission: Your draft of the third-party payment systems and the operational and strategic planning in healthcare portions of your research and analysis should be 2–3 pages in length and should be double-spaced in 12-point Times New Roman font with one-inch margins, in a single Microsoft Word document. All citations and references should be formatted according to current APA guidelines. Include at least two references.

Critical Elements Proficient (100%) Needs Improvement (70%) Not Evident (0%

"Get 15% discount on your first 3 orders with us"
Use the following coupon
"FIRST15"

Order Now

Related posts:

  1. Strategic Management Presentation
  2. External Environmental Factors Impact in Strategic Planning
  3. Course Project: Developing a Strategic Plan In Week 6, you began to develop a summary of the issue you are addressing through your Course Project. This week, you continue to refine the summary and engage in a SWOT analysis related to the identified unmet need. Section 1: Summary of the Issue As introduced in Week 6,continue to develop, write, and refine a 2- to 3-page summary of the issue you are addressing through the creation of a strategic plan. (Refer to Week 6 for the preparatory instructions as necessary). To complete: Create a 2- to 3-page summary of the issue, in which you identify and/or describe: The unmet need and how it is evident in the specific group, unit, or organization The mission, vision, and values of the group, unit, or organization Background, including: Data from historical analysis and forecasting Evidence from the literature What has been attempted in the past by various individuals and groups to address this need Which stakeholders should be included in the strategic planning process Initial vision for addressing this need at the institutional or systems level, including at least one strategic goal Broader issues to be considered
  4. Strategic Financial Planning in Healthcare