Healthcare Reimbursement

Reimbursement and the Revenue Cycle

1. What does reimbursement mean to a healthcare organization? What would happen if services were provided to patients but no payments were received for these services?
2. How does 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? Also identify the departments in order of importance to the revenue cycle.

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? Why is collecting data required for pay-for-performance incentives.

B. Describe the activities within each department for how they may impact reimbursement. What specific data would you review in the reimbursement area to know whether changes were necessary?

C. Who is 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?

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

D. What's 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

Marketing and Reimbursement

A. How does 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.

C. What are some strategies to ensure stakeholders involved in the reimbursement process adhere to ethical standards?