Healthcare Reimbursement

III. Billing and Reimbursement

a. 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. How do third party policies impact the payer mix for maximum reimbursement?

b. 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.

c. Describe a way to structure your follow-up staff in terms of effectiveness. How can you ensure that this structure will be effective?

d. 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.

IV. Marketing and Reimbursement

a. How is new managed care contracts impact reimbursement for the healthcare organization. Support your explanation with concrete evidence or research.

b. What are 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.

c. What strategies to use to ensure stakeholders involved the reimbursement process adhere to ethical standards.