IHP 630 Final Project Submission
Analysis and Report
Professor: Dr. Susan Aloi
Southern New Hampshire University
April 25, 2021
Table of Contents
Financial Principles and Reimbursement 4
Federal and State Payment Systems. 10
Third-Party Payment Systems and Planning in Healthcare. 14
Due to the current state of the world and the range and quality of healthcare services, it is important to distinguish between the systems and their incentives for providers. In addition, it is crucial to understand the various federal and state payments systems, such as Medicaid and Medicare. Both options are structurally different and have different payment systems which may have different implications for organizations. Third-party payment systems and reimbursement methods are imperative for hospital administrators. The ease of access to new plans and the percentage of uninsured customers and maintaining track of accounts may pose unique challenges to each provider. The aim of this paper is to assess the types of payment systems, how these systems work at the federal and state level and how third-party payment systems come into play at an organization. This paper will also outline compliance standards, reporting requirements and for federal and state systems as well as third party payment systems.
The health care system is slowly moving from a pay-for-volume to a pay-for-value system ready to offer quality health care to patients (Forsberg, Axelsson & Arnetz, 2014). The pay-for-volume system is where the healthcare provider is reimbursed one payment which covers a range of services a patient typically needs for a set duration of time. Whereas the pay for value system is the structure in which healthcare providers are paid based on the quality of care they provide to their patients. This system can be measured by the level of coordination for patient care, treatment and the ramifications on overall health, satisfaction of patients and their engagement with the organization. The aim should be to provide patients with a high level of care and service.
Some of the reimbursement strategies being used include data aggregation efforts, analysis, and predictive modeling to identify and manage the patients with the highest risk. The advantage of the strategies is that about forty percent of patients need not be present if enough information is acquired. However, these strategies and the pay-for-value system require costly infrastructure that is not available in most countries, mostly in Africa and Latin America, making the whole system hard to execute.
Some pros of the pay for value system are the reduced chances of hospital readmission and the high quality of care and treatment patients receive. Healthcare organizations are incentivized to keep their readmission rates low in order to receive maximum reimbursement for the pay for value system. Whereby, some cons of the pay for value system can be loopholes in the system where patients may not actually receive the highest quality of care because the quality standards may vary among organizations, some organizations may not have the infrastructure to properly maintain reporting standards for the pay for value system, and healthcare providers are sometimes forced to only focus on the specific issues while overlooking other areas which may affect the quality of care.
There are three main forms of reimbursement in the healthcare marketplace: Capitation, Fee-for-Service, and Bundled Payments/Episode-Based Payments. Capitation is the system in which healthcare providers are paid a fixed amount per patient by an insurance company for a predetermined duration of time and can present advantages such as moderate administrative costs and more efficiency for medical providers. On the other hand, some cons include its high financial risk that can cripple the provider financially. An example of capitation can be where an organization is reimbursed $1,000 for each patient. However, at the time of rendering services, the actual charges total $2000, which means that the organization makes a loss of $1,000. If this loss is occurring for hundreds of patients, the organization’s profitability will be in serious jeopardy. This may be resolved by taking in patients with lower risks can manage the risks involved.
Under the Fee-for-Service model, healthcare providers are reimbursed for each service renders to the patient. Like capitation, this includes incentives for the provider to provide their services efficiently. However, the downside is that the expenses incurred may be unpredictable, making it hard to budget for the method. Another downside is that practitioners may place sole focus on the volume of patients and services that quality of care may not be of high quality and there may be instances in which providers perform services which may not even be necessary to boost their reimbursement.
Bundled Payments/Episode-Based Payments, which have grown in popularity since the inception of American Care Act, can be considered a combination of fee-for-service reimbursement and capitation. Providers get reimbursed for the various individual procedures required as a part of the entire episode of care, but only for what is expected to be required. However, if a provider has a more severe situation than is considered in the pricing of the episode, they will be underpaid for the episode of care. An example of the bundled payment system is that the healthcare provider is that if a surgery is performed, a patient will be charged a set or bundled price for all services rendered and not pay for service.
A common principle is financial data which is essentially the first and crucial step to wealth creation. The principle can be efficiently met through software that makes the whole process easier when operating and referring to the data (Casto & Forrestal, 2013). The other principle involves diversification of one’s resources to hedge against risk. Importantly one ought to understand the risks involved in wealth creation: the more the risk, the better the returns.
Proper financial management includes a phase in which involves the evaluation of the financial efficiency of the organization’s operations and using these outcomes to plan for the future, determining investment opportunities, such as software upgrades and improved facilities, which can benefit the organization in the long term and identifying totals costs for implementation, and acquiring the finance and managing the working capital to ensure that plans are appropriately carried out. The main goal of the organization should be to strengthen the financial stability of the organization by reducing their exposure to risk. In doing so, organizations will be able to provide high quality care while attaining their financial goals.
Account’s receivable is becoming really common in most organizations since it can be a challenge to get the clients to pay by the agreed-upon date. Some challenges include less control; since one can never be sure when and if their clients will make their payments which may eventually affect the organization’s processes. Moreover, for checks and balances, an organization must take accountability for every client and the funds they owe. One benefit involves saving time since many organizations need to profit from their sales as fast as possible, and accounts receivable allow for fast transactions between organizations and clients.
A main goal of the organization should be to attain and manage higher cash flows and reduce the instances of collection and an overall decrease in all related costs of collecting overdue bills. Given the increasing risk of non-payment by patients, it is important for healthcare organizations to ensure that they strengthen their collection procedures and implement systems in place to continuously monitor their cash flows. Organizations should perform annual audits, monitor receivables monthly, identify the optimum billing terms for their organization (60 days, 90 days, etc.) and conduct data analytics to draw conclusions on how to make their receivables more efficient.
For any organization, teamwork is part of the game and helps get things done quickly and effectively. Some important principles include proper communication, accountability for one’s work and mistakes if they arise, respect, proper resource allocation, and appreciation for diversity. Teamwork is crucial since the members can share ideas and improve their creativity and innovation, thus contributing to the entire organization’s success. One major challenge is poor leadership, as it can affect the entire team’s collaboration and effectiveness.
Organizations should consider following the Team STEPPS which was developed with the aim of improving teamwork and transparency across the organization. To introduce Team STEPPS, organizations need to create a detailed plan for implementation and training for all staff across the organization. By utilizing the Team STEPPS, organizations can ensure an increase in quality of care given to patients, transparency on the roles and accountabilities or team members, and giving rise to better safety practices. By improving teamwork and transparency among the teams, organizations can ensure that their departments are operating efficiently and for the best interests of the patients.
As healthcare becomes more of a global concern, mostly during the pandemic, healthcare organizations are becoming better at managing their reimbursements from third parties and the government for better patient care and hospitals’ financial stability. The whole system is like a cycle, and the failure of one part can affect the whole system making it crucial to manage the reimbursements thoroughly and carefully.
Organizations should place adequate focus on analyzing case rates and using available data on management utilization to identify their maximum reimbursement. If the system is pay-for-value, the organization should improve and offer the highest the quality of care to their patients, thereby reducing readmission rates and maximizing their reimbursement. In this system, healthcare providers are rewarded for their high-quality services and low readmission rates for their patients. If the system is pay-for-volume, organizations will seek to maximize their reimbursement by offering and performing large numbers of services for their patients. Maximizing reimbursement is crucial to ensure organizations can smoothly continue its operations.
The most profound federal health funding system in America is Medicare. On the other hand, America has Medicaid run by individual states (Rosenkrantz et al., 2017). Medicare is managed based on the applicant’s age, while the states manage Medicaid based on their annual income. Medicare covers all American citizens and qualified non-citizens, including low-income adults, pregnant women, elderly adults, and children. On the other hand, the Medicare program covers older adults above 65 years, but under special conditions like disability, it considers young people with disabilities (Rosenkrantz et al., 2017). According to reimbursement and financial principles, Medicaid pays for value while Medicare pays for volume. Indeed, only 20% of the Medicare spending is value-based, but Medicaid has advanced its expenditure to put up with many value-based models and efficiently improve healthcare outcomes (Rosenkrantz et al., 2017). The paper explores federal statement payment systems based on federal and state regulations, reporting requirements, compliance to the standards and financial principles, and government payer types.
Federal and State Regulations
In the last few years, the federal government and Georgia state government have had different economic policy changes. The federal government provides broader support to many households and families whose members are unemployed. Under SNAP programs, participants in the government unemployment programs have been provided with cash aids and other bonuses that round off their income tax credits (Silva III et al., 2016). The government has also sent checks to many households to provide them with spending necessities and reduce the withheld potentials by boosting home pay. On the other hand, the Georgia government has increased funds to mobilize more investments and financial intermediation (Silva III et al., 2016). Therefore, Georgia is likely to have a competitive private sector and with more sophisticated human resources. Georgia has also shared a significant consensus with the national priorities for growth and citizens’ welfare.
The changes attained by the federal government are significant to the healthcare leaders because they present opportunities that can be used to propose changes in the Medicare program (Nuckols, 2017). With the idea that the government is concerned about the unemployed, the government would extend Medicare’s scope to cover a significant portion of American citizens. Healthcare leaders can propose new amendments in Medicare’s coverage to encompass unemployment and cover diseases that affect a more substantial American population. Considering the changes in Georgia, healthcare leaders can propose new Medicaid considerations (Nuckols, 2017). For instance, the leaders can request private considerations that will set workers and business owners at an advantage of the customized insurance programs.
The Medicare and Medicaid programs use EHR for reporting purposes which are eligible to the clinicians and other healthcare professionals. Medicaid value-based payments have been based on the healthcare systems’ accountability requirements and specialized EHR systems (Nuckols, 2017). Under the influence of Medicare, the EHR systems have evolved and turned into population-based payment systems. Therefore, Medicaid and Medicare programs have adapted to shared accountability systems to increase their attribution and responsibility (Bijlmakers et al., 2020). Medicaid and Medicare programs have an opportunity to interact with EHR systems that allow smarter spending, better care, and healthier people. Healthcare leaders have engaged a multidisciplinary group that offers better input and outputs in the fund claims and creates reliable healthcare management information.
The Medicaid value-based spending reports on quality, resource use, and clinical activities involved. On the other hand, Medicare population-based spending reports on the number of cases funded. Medicaid has more medical files and patients’ records than Medicare, making it very engaging and tedious (Nuckols, 2017). Therefore, Medicaid is likely to have more errors when integrating unique perspectives about its clients. The Medicaid budget depends on state administration, meaning it has limited options even when presented with many opportunities (Bijlmakers et al., 2020). On the other hand, Medicare has significant challenges when aligning its measures with different concepts and other core healthcare industry measures. Medicare has limited data that prevents it from the accurate definition of the shared data.
Compliance Standards and Financial Principles
Medicaid and Medicare have had written policies and procedures from the state and federal governments, respectively. Besides, the firms have had compliance officers who report to the selected compliance committees (Rosenkrantz et al., 2017). Medicaid and Medicare abide by the hospital governing body’s directives, which calendars the dates for disbursements and funded cases. Therefore, the governing body coordinates activities between the healthcare leaders and the funding bodies to enhance service continuity.
Medicaid reimburses funds based on the value they pay for, meaning its financial principles are grounded on data aggregation and analysis (Casto, 2018). On the other hand, Medicare reimburses funds based on the population served each period by easily integrating the information acquired. Under these conditions, Medicaid has a more challenging task executing its plans but has maintained its reimbursement methods by apprehending its financial management principles (Casto, 2018). Medicaid manages risk better than Medicare because its reimbursement requires fine details to be validated when reporting (Sweeney, 2019). Each of the two funding systems complied with the budget requirements and other government directives to reduce sanctions and other harsh government control measures.
Government Payer Types
Since Medicaid and Medicare are developed to cover fixed costs, they should write government papers that describe the covered expenses. The business model would also ensure the occupational facilities are constructed in the healthcare sector where an insurance claim is obtained (Dang, Dang, & Vallish, 2021). For instance, a partner hospital can section its departments based on urgency and ensure that the insurance cover knows the state of need. Having emergency departments in a hospital will enhance timely disbursements, reduce costs and create new overheads. Methodological papers will ensure that the reimbursement rates are higher and accurate because Medicaid will get processed data ready for use. Therefore, hospitals will be motivated to offer quality care at reduced costs (Dang, Dang, & Vallish, 2021). Additionally, the use of specialized claims on insurance coverage will eliminate wastes of time and resources because the papers used would uphold the patient value and maintain compliance with governmental policies.
Healthcare System Reimbursement
The effectiveness of a healthcare payment module is measured by the ability to improve patient outcomes and effectively pay physicians. Numerous healthcare reimbursement models have been formed, each with different impacts on healthcare. The most common payment module is the Fee-For-Service which requires the payment of medical practitioners for every service performed (Casto & Layman, 2013). The module does offer the sector incentive towards cost-saving measures, reduced hospitalization, and preventive care strategies. Additionally, the lack of mandated up-front payment at the time of service using the model can cause losses and lag in payment collection. Another type of reimbursement module is the Pay-For-Performance (P4P), this value-based payment module ensures medical professionals are only compensated after meeting specific quality and efficiency standards (Casto & Layman, 2013). This ensures increased efficiency and quality of medical care and better patient outcomes.
Healthcare organizations must follow basic reporting requirements while seeking reimbursement from third-party payers. The reporting begins with continuous monitoring of accounts from registration to clearance (Nuckols, 2017). This allows facilities to track payment cycles thus promoting fewer errors and timely payments (Sweeney, 2019). To effectively meet reporting requirements, service providers must have effective hospital recording systems. A challenge for the process can arise from physician and staff poor analysis of the patient billing process. Faulty documentation systems can increase payment denial rates, delayed collections, and financial losses.
Compliance standards concerning finances ensure hospitals effectively handle financial resources. Healthcare is a business like any other and effective financial management is a skill needed in all medical practitioners. Financial principles are used by hospitals to ensure payment claims are proportionate to services rendered while still making business profits (Casto & Layman, 2013). Healthcare firms ensure compliance by hiring competent employees with documentation of services provided and payment made in an accounting format. This also ensures medical providers seal loopholes providers use to fraud insurers through hiked costs. Facilities are also encouraged to equip medical staff with proper continuous training and accountability in inpatient documentation.
The technical and operational aspects of the healthcare industry are shifting to a value-based approach. Financial management falls under the technical side and can incorporate accounts receivable. Facilities still using manual systems to assess claims have higher rates of error and long periods before the transition from provider to the third-party payer. The use of technology in this area can ensure effective claims tracking thus improving reimbursement timeliness (Dang et al., 2021). Additionally, through primary care capitation, insurers make fixed payments to providers for the care given irrespective of quantity provision. The model places a performance risk on medical practitioners through financial incentives limiting unnecessary services, thus ensuring full reimbursement (Forsberg et al., 2014).
Operational and Strategic Planning in Healthcare
A hospital as a business thrives by ensuring the continuous increase of the quality of its care delivery processes. As a result, the number of patients receiving medical services should not exceed care quality. Pay-For-Performance is a suitable strategic approach towards the improvement of healthcare quality. The performance incentive will improve all aspects of healthcare outcomes, processes, and structure ultimately maximizing reimbursement. The Pay-For-Performance model also emphasizes preventive care. By contributing to all aspects of care, healthcare organizations are not seen as businesses alone. Preventive care takes medical care outside the medical care process that significantly reduces overall healthcare costs and improves patient experiences in healthcare facilities.
Operational Performance Measures
Numerous performance measures should be maximized to maximize reimbursement. First, the process metrics need to be monitored to ensure positive outcomes. Measuring the outcomes start with setting performance goals and educating medical staff on outcomes, their value, and their impact on both practitioners and the organization. Training should focus on payment data examination to identify errors in demographic information, coding, and documentation (Erickson et al., 2020). Another performance is the cost metrics, continuous monitoring of this measure ensures the effective use of financial resources.
Teamwork and Strategic Planning
Teamwork is part of a hospital’s operational side of the business. After sorting the technical side, the operational side should also be improved to streamline the care delivery process. Healthcare is an organization that is interconnected and relies on collaboration to ensure success. The entire workforce must then maintain a tight-knit relationship from top to bottom to ensure collective compliance with reimbursement requirements (Rosen et al., 2018). Healthcare organizations must provide continuous teamwork training to reduce the chances of errors in sharing of information. A principle guiding reimbursement mandates dismissal of payment claims over inaccurate or false data. Essentially, a cohesive workforce maintains facility integrity and maximum reimbursement.
Communicating Strategic Planning Across Teams
Communicating strategic planning to stakeholders must vary based on urgency, relevance, and clearance. Key stakeholders and medical staff should meet through face-to-face meetings when urgent and emails and zoom for informal issues. Cross-disciplinary practitioners will also meet using these tools (Erickson et al., 2020). Third-party payers can be communicated with through a website of the hospital chat box. The website can also be used to communicate with patients and potential investors.
Financial and Reimbursement Strategies
Improving accounts receivable for both high and low-performing healthcare system begin with determining facility benchmarks and translating that to the staff (Ham, 2010). Account’s receivables must be effectively analyzed through examination of patient AR from third-party payers. Verification of the payment process and collaboration with third-party payers is crucial in receiving the right information for the reimbursement process.
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