HCM 345 Healthcare Reimbursement:3-2 Final Project Milestone One: Draft of Departmental Impact on Reimbursement
For your final project, you will assume the role of a supervisor within a PFS department and develop a white paper in which the necessary healthcare reimbursement knowledge is outlined.
In Milestone One, you will take a closer look at how reimbursement impacts other healthcare departments, and you will dive deep into analyzing the revenue cycle, utilizing data, tracking records, and ensuring compliance within individual departments.
Pay-for-performance is a requirement for Medicaid Managed Care, Medicare, and commercial plans, requiring reporting on quality outcomes.
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 Cycle
a. Describe what reimbursement means to a healthcare organization. What would happen if services were provided to patients but no payments were 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 payment is collected.
II. Departmental Impact on Reimbursement
a. Many different departments utilize reimbursement data in a healthcare organization. It is crucial the healthcare organization monitors this data.
What impact could the healthcare organization face if this data were not monitored? Describe why collecting data is required for pay-for- performance incentives.
b. Describe the activities within each department in a healthcare organization for how they may impact reimbursement. What specific data would you 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 on
reimbursement in a healthcare organization?
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