Imagine that you have just stepped into a new role as the office manager for a very successful clinic. The clinic is a conglomeration of physicians who offer specialized care. Each group of physicians tried to manage their own billing process but it quickly became obvious that one billing office would be more efficient. You realize that there has been a lack of consistency in the clinic and that you will need to update the billing policies and procedures immediately. You also realize that there is always resistance to change, and you will need to provide evidence supporting the changes you plan to make.

Prepare a proposal for billing changes that you would present to the physicians. You will need to support each proposed change with relevant evidence to assure buy-in from the physicians.

There is no specific format you must follow for this assessment, but be sure that your proposal is clear, logical, and succinct.

Proposal for billing changes for Medicare, Medicaid, and Managed Care, and explain how the proposed changes will benefit the organization, the physicians, and the patients.

Regardless of the corporate structure, health care organizations must remain financially viable. Income must be forecasted according to existing contracts with stakeholders, such as insurers and private payers and state and federal payers.

What changes you would like to make to the billing policies and procedures in a successful physicians clinic. Include the following in your proposal:

• Develop a step-by-step process for the entire revenue cycle from pre-verification of insurance to accounts receivable management.
• Recommend a method for determining a pricing structure. What factors can influence pricing?
• Explain the factors that must be considered while negotiating insurance contracts. What major payer categories are appropriate for this practice?
• Explain how the clinic will handle private pay and charity care.
• Recommend either an installed or a web-based billing software system. (Please note that you should not recommend a specific brand of software; just the type of software.)
• Explain how the changes will benefit the physicians, the clinic, and patients.