Loading...

Messages

Proposals

Stuck in your homework and missing deadline? Get urgent help in $10/Page with 24 hours deadline

Get Urgent Writing Help In Your Essays, Assignments, Homeworks, Dissertation, Thesis Or Coursework & Achieve A+ Grades.

Privacy Guaranteed - 100% Plagiarism Free Writing - Free Turnitin Report - Professional And Experienced Writers - 24/7 Online Support

Strategies used to negotiate new managed care contracts

27/10/2021 Client: muhammad11 Deadline: 2 Day

Milestone Two: Draft Of Billing, Marketing, And Reimbursement

HCM 345 Milestone Two Guidelines and Rubric

Overview: Much of what happens in healthcare is about understanding the expectations of the many departments and personnel within the organization. Reimbursement drives the financial operations of healthcare organizations; each department affects the reimbursement process regarding timelines and the amount of money put into and taken out of the system. However, if departments do not follow the guidelines put into place or do not capture the necessary information, it can be detrimental to the reimbursement system.

An important role for patient financial services (PFS) personnel is to monitor the reimbursement process, analyze the reimbursement process, and suggest changes to help maximize the reimbursement. One way to make this process more efficient is by ensuring that the various departments and personnel are exposed to the necessary knowledge.

Milestone Two provides you an opportunity to engage with real-world data and tools that you would encounter in an actual professional environment. Specifically, you will begin thinking about reimbursement in terms of billing and marketing. Reimbursement is a complex process with several stakeholders; this milestone allows you to begin thinking about the key players, including third-party billing, data collection, staff management, and ensuring compliance. Marketing and communication also plays a vital role in reimbursement; this milestone offers a chance to begin analyzing effective strategies and their impact. Prompt: Submit your draft of Sections III and IV of the final project. Specifically, the following critical elements must be addressed:

III. Billing and Reimbursement

a. Analyze the collection of data by patient access personnel and its importance to the billing and collection process. Be sure to address the importance of exceptional customer service.

b. 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.

c. 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.

d. Describe a way to structure your follow-up staff in terms of effectiveness. How can you ensure that this structure will be effective? e. 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. Analyze the strategies used to negotiate new managed care contracts. Support your analysis with research. b. Communicate the important role that each individual within this healthcare organization plays with regard to managed care contracts. Be sure to

include the different individuals within the healthcare organization. c. Explain how new managed care contracts impact reimbursement for the healthcare organization. Support your explanation with concrete

evidence or research.

2

d. Discuss 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.

Rubric

Guidelines for Submission: Your draft must be submitted as a three- to five-page Microsoft Word document with double spacing, 12-point Times New Roman font, one-inch margins, and at least three sources, which should be cited in APA format.

Critical Elements Proficient (100%) Needs Improvement (75%) Not Evident (0%) Value

Billing and Reimbursement: Data

Analyzes the collection of data by patient access personnel and its importance to the billing and collection process, including the importance of exceptional customer service

Analyzes the collection of data by patient access personnel and its importance to the billing and collection process but does not include the importance of exceptional customer service

Does not analyze the collection of data by patient access personnel

10

Billing and Reimbursement: Third-

Party Policies

Analyzes how third-party policies would be used when developing billing guidelines for PFS personnel and administration when determining the payer mix for maximum reimbursement

Analyzes how third-party policies would be used but does not apply analysis toward the development of billing guidelines for PFS personnel and administration or toward the determination of the payer mix for maximum reimbursement

Does not analyze how third-party policies would be used

10

Billing and Reimbursement: Key

Areas of Review

Organizes and explains the key areas of review in order of importance for timeliness and maximization of reimbursement from third-party payers

Organizes and explains the key areas of review in order of importance for timeliness and maximization of reimbursement from third-party payers, but explanation is cursory or illogical

Does not organize and explain the key areas of review in order of importance for timeliness and maximization of reimbursement from third-party payers

10

Billing and Reimbursement:

Structure

Describes a way to structure follow-up staff in terms of effectiveness and explains rationale for effectiveness

Describes a way to structure follow-up staff in terms of effectiveness but does not explain rationale for effectiveness

Does not describe a way to structure follow- up staff in terms of effectiveness

10

Billing and Reimbursement: Plan

Develops a plan for periodic review of procedures to ensure compliance, including explicit steps and the feasibility of enacting the plan

Develops a plan for periodic review of procedures to ensure compliance but does not include explicit steps or does not include the feasibility of enacting the plan

Does not develop a plan for periodic review of procedures to ensure compliance

10

Marketing and Reimbursement:

Strategies

Analyzes the strategies used to negotiate new managed care contracts, supporting analysis with research

Analyzes the strategies used to negotiate new managed care contracts but does not support analysis with research

Does not analyze the strategies used to negotiate new managed care contracts

10

3

Critical Elements Proficient (100%) Needs Improvement (75%) Not Evident (0%) Value

Marketing and Reimbursement:

Communicate

Communicates the important role that each individual within this healthcare organization plays with regard to managed care contracts, including the different types of individuals within the organization

Communicates the important role that each individual within this healthcare organization plays with regard to managed care contracts but does not include the different types of individuals within the organization

Does not communicate the important role that each individual within this healthcare organization plays with regard to managed care contracts

10

Marketing and Reimbursement:

Contracts

Explains how new managed care contracts impact reimbursement for the healthcare organization, including support for explanation with concrete evidence or research

Explains how new managed care contracts impact reimbursement for the healthcare organization but does not include support for explanation with concrete evidence or research

Does not explain how new managed care contracts impact reimbursement for the healthcare organization

10

Marketing and Reimbursement:

Compliance

Comprehensively discusses the resources needed to ensure billing and coding compliance with regulations and ethical standards

Discusses the resources needed to ensure billing and coding compliance with regulations and ethical standards, but discussion is not comprehensive

Does not discuss the resources needed to ensure billing and coding compliance

10

Articulation of Response

Submission has no major errors related to citations, grammar, spelling, syntax, or organization

Submission has major errors related to citations, grammar, spelling, syntax, or organization that negatively impact readability and articulation of main ideas

Submission has critical errors related to citations, grammar, spelling, syntax, or organization that prevent understanding of ideas

10

Homework is Completed By:

Writer Writer Name Amount Client Comments & Rating
Instant Homework Helper

ONLINE

Instant Homework Helper

$36

She helped me in last minute in a very reasonable price. She is a lifesaver, I got A+ grade in my homework, I will surely hire her again for my next assignments, Thumbs Up!

Order & Get This Solution Within 3 Hours in $25/Page

Custom Original Solution And Get A+ Grades

  • 100% Plagiarism Free
  • Proper APA/MLA/Harvard Referencing
  • Delivery in 3 Hours After Placing Order
  • Free Turnitin Report
  • Unlimited Revisions
  • Privacy Guaranteed

Order & Get This Solution Within 6 Hours in $20/Page

Custom Original Solution And Get A+ Grades

  • 100% Plagiarism Free
  • Proper APA/MLA/Harvard Referencing
  • Delivery in 6 Hours After Placing Order
  • Free Turnitin Report
  • Unlimited Revisions
  • Privacy Guaranteed

Order & Get This Solution Within 12 Hours in $15/Page

Custom Original Solution And Get A+ Grades

  • 100% Plagiarism Free
  • Proper APA/MLA/Harvard Referencing
  • Delivery in 12 Hours After Placing Order
  • Free Turnitin Report
  • Unlimited Revisions
  • Privacy Guaranteed

6 writers have sent their proposals to do this homework:

Finance Master
Maths Master
Coursework Help Online
Engineering Mentor
Top Class Engineers
Engineering Guru
Writer Writer Name Offer Chat
Finance Master

ONLINE

Finance Master

I have read your project description carefully and you will get plagiarism free writing according to your requirements. Thank You

$32 Chat With Writer
Maths Master

ONLINE

Maths Master

I am an experienced researcher here with master education. After reading your posting, I feel, you need an expert research writer to complete your project.Thank You

$16 Chat With Writer
Coursework Help Online

ONLINE

Coursework Help Online

I have worked on wide variety of research papers including; Analytical research paper, Argumentative research paper, Interpretative research, experimental research etc.

$46 Chat With Writer
Engineering Mentor

ONLINE

Engineering Mentor

After reading your project details, I feel myself as the best option for you to fulfill this project with 100 percent perfection.

$26 Chat With Writer
Top Class Engineers

ONLINE

Top Class Engineers

I find your project quite stimulating and related to my profession. I can surely contribute you with your project.

$18 Chat With Writer
Engineering Guru

ONLINE

Engineering Guru

I have read your project details and I can provide you QUALITY WORK within your given timeline and budget.

$41 Chat With Writer

Let our expert academic writers to help you in achieving a+ grades in your homework, assignment, quiz or exam.

Similar Homework Questions

Five components of service quality - What is genetic mutation jiskha - Article - Average speed formula with two speeds - Requirement traceability matrix for online shopping - Supply chain management ppt mba - Business intelligence questions - Alan moore v for vendetta introduction - Disaster Recovery Plan - Iousa 30 minute questions answers - Hoover's martial arts brandon sd - Fronius ig 40 datasheet - A forecasting method has produced the following - MGT - APA 7TH EDITION (3) - 9999 lost fork rd manchester ky 40944 - Amps per hour to watts - Taxes - Baptist spiritual gifts test - Global business today mcgraw hill - Rural vs. Urban Ancillary Services Discussion Response - Bsbldr502 lead and manage effective workplace relationships pdf - I wanna be poem - Droplet growth by condensation - Apply: Signature Assignment: Strategic Management Research Project - Discussion 3 - Apocalypse of james password - CRYPTOGRAPHY AND COMPUTER FORENSICS - Titanic the story of the unsinkable ship pdf - Plan symbols and abbreviations - Synthes product catalog pdf - Tonga toys manufactures and distributes a number - Donald wheres your trousers chords - Project Plan - Maxwell boltzmann distribution catalyst - Tennis court dimensions australia - Adding ly rules powerpoint - World religion and culture - Https owl english purdue edu owl resource 560 11 - Polishing your penmanship barbara nichol pdf - A proper journal entry to record issuing raw materials to be used on a job would be: - Cause-and-Effect Essay - Sampling variation is caused by - Create a conference room scheduler PHP web application. - Dr. biasiotto basketball study - Martinez, inc., has a total debt ratio of .65, total debt of $345,000, and net income of $31,280. - Why does a fall in the value of the australian dollar against the u.s. dollar benefit billabong - Handling inmate or offender manipulations and setting boundaries - Service specification in iot - Complexity of Information Systems Research in the Digital World - Dell code tester for oracle - Equilibrium constant keq worksheet answers - Er diagram for football league management system - Atkinson's flexible firm model - Business Valuation - Which resource will help you revise colorless word choice in a draft autobiography? - Normalcdf in excel - Solid ink color printer - Georgy girl ukulele chords - Wzzm13 on your sidelines scores - Jesus and the spiral of violence - Assetto corsa disable damage indicator - Alostar bank of commerce atlanta ga - Fahrenheit 451 green bullet - Discussions - Chern's case study executive summary - Get wiggy with it kingman az - Presentation. Computer Science 302 - Need 5+ pages with no plagiarism 2+ scholarly references in APA 7 Format.Follow all instructions. - Match each term with the correct definition - How many chapters are in the secret life of bees - William graham sumner argued that distinguishing between our ingroups and our outgroups helps us: - National gang intelligence center - The first step in the screening process for potential markets and sites is to ________. - Probate application form pa3 - Your company assembles five different models - How to find the spring constant from a graph - First Steps on Becoming a Grassroots Lobbyist/Advocate for Health Care Policy - What criteria concerning moral judgments should we agree with - Riverview community hospital case study answers - Medicare cheat sheet skin lesions - Schizophrenia - Disney characters with bipolar disorder - Ibm z13 operating system - The gypsy moth is a serious threat to oak - A raisin in the sun pdf - Insulation resistance test nz - CY d9 - 22 betterton street london wc2h 9bx - According to economy from walden what happened before the framing - Bonnie bassler how bacteria talk summary - The ugly american chapter 1 summary - Week 5 - Assignment: Plan Data Collection Effort for Informed Decision Making - History - Frances glessner lee nutshell answers - Family resources in home economics - Escape from the western diet they say i say essay - Cuban missile crisis notes - Truvision navigator 7 default password - 2 pages question