Develop financial strategies

Description

 

 

Write a 3–4-page proposal for billing changes, and explain how the proposed changes will benefit the organization, the physicians, and the patients.

Note: The assessments in this course build upon each other, so you are strongly encouraged to complete them in sequence.

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By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

  • Competency 1: Develop financial strategies to address dynamic environmental forces. (L24.2, L24.5, L17.2)
    • Develop a step-by-step process for a revenue cycle.
    • Recommend a pricing structure method.
  • Competency 2: Analyze the cost and revenue implications for organizational changes due to environmental forces. (L18.2, L12.1)
    • Explain the factors to consider for insurance contract negotiations.
    • Explain a process for handling private pay and charity care.
    • Recommend a billing software system.
    • Explain how billing process changes benefit physicians, clinics, and patients.
  • Competency 4: Communicate in a manner that is scholarly, professional, and consistent with expectations for professionals in health care administration. (L6.1, L6.2, L6.3, L6.4)
    • Write content clearly and logically with the correct use of grammar, punctuation, and mechanics.
    • Format citations and references using the APA style.
    • 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.SHOW LESSHealth care leaders must also deal with the reality of finite resources, including caring for patients with limited or no resources. The Emergency Medical Treatment and Active Labor Act (EMTALA) requires triage and emergency care for patients in need (Social Security Administration, n.d.). Health care executives are responsible to support emergency care, and they must manage finite resources to achieve this legal imperative.Reference
      Social Security Administration. (n.d.). Compilation of the social security laws. Retrieved from http://www.ssa.gov/OP_Home/ssact/title18/1867.htm

To deepen your understanding, you are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community.

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  • What resources are available to help patients with no insurance and no financial means to pay for health care?
  • How can an organization be financially prepared to handle uninsured patients?Suggested Resources
    The resources provided here are optional and support the assessment. They provide helpful information about the topics. You may use other resources of your choice to prepare for this assessment; however, you will need to ensure that they are appropriate, credible, and valid. MHA-FP5006: Health Care Finance and Reimbursement Library Guide can help direct your research. The Supplemental Resources and Research Resources, both linked from the left navigation menu in your courseroom, provide additional resources to help support you.The chapter in the following book contains information on revenue cycle management:

    • Harrison, C., & Harrison, W. P. (2013). Introduction to health care finance and accounting. Clifton Park, NY: Cengage Learning/Delmar. Available in the courseroom via the VitalSource Bookshelf link.
      • Chapter 11, “Revenue Cycle Management,” pages 197–212.
    • The chapters in the following textbook contain information on billing and coding for health services, the financial, legal, and regulatory environment for health care organizations, revenue determination, and managed care:
    • Cleverley, W., & Cleverley, J. (2018). Essentials of health care finance (8th ed.). Burlington, MA: Jones & Bartlett. Available in the courseroom via the VitalSource Bookshelf link.
      • Chapter 2, “Billing and Coding for Health Services,” pages 10–29.
      • Chapter 3, “Financial Environment of Healthcare Organizations,” pages 30–56.
      • Chapter 4, “Legal and Regulatory Environment,” pages 96–129.
      • Chapter 6, “Revenue Determination,” pages 150–169.
      • Chapter 7, “Health Insurance and Managed Care,” pages 170–193Additional Resources for Further Exploration
        You may use the following optional resources to further explore topics related to competencies.Coding and Reimbursement
        This website focuses on medical billing and revenue cycle management, and it has helpful links to education and publications on these topics.