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The final project for this course is the creation of a payment system and reimbursement method analysis and a report to management.
The healthcare industry is impacted by government payer types as administrators prepare strategies and implement internal procedures designed to maximize
reimbursement. You are reminded that the primary focal point between healthcare firms and other business operations is the payment method. Healthcare
administrators implement strategies designed to meet key performance payment requirements critical for government compliance and reimbursement
guidelines. One way administrators accomplish this is to analyze deficiency errors based on quality measures performed by providers, nursing staff, and front
desk operations. The Affordable Care Act and other changes in legislation are of continual concern for healthcare organizations as administrators review changes
to ensure organizational processes and internal policies are implemented.
Your final project for this course is an analysis with recommendations. The project will require you to prepare an analysis of payment systems and reimbursement
methods. You will compare and contrast your findings and offer subsequent recommendations. You will consider compliance and government regulations along
with financial principles associated with reimbursement. You will also identify collaborative teamwork strategies that can be incorporated into various healthcare
settings.
The project is divided into three milestones, which will be submitted at various points throughout the course to scaffold learning and ensure quality final
submissions. These milestones will be submitted in Modules Three, Five, and Seven. The final submission is due in Module Nine.
In this assignment, you will demonstrate your mastery of the following course outcomes:
 Assess the extent to which healthcare organizations utilize financial management principles for guiding strategic planning
 Analyze federal, state, and third-party payer regulations and reporting guidelines for ensuring compliance with healthcare reimbursement requirements
 Recommend collaborative teamwork principles for improving strategic planning processes involving healthcare reimbursement
 Suggest financial approaches for improving cash flow, days in accounts receivable, and timeliness of reimbursements from various healthcare payer
models
 Recommend strategies for maximizing healthcare reimbursement by reviewing the impact of case rates and management utilization data on pay-forperformance incentives
Prompt
Your analysis with recommendations should answer the following big-picture questions: What reimbursement payment methods and strategies are associated
with the healthcare industry? How do financial management principles relate to reimbursement in evaluating operational performance? And, how does the
revenue cycle affect various departments within the healthcare organization?
Specifically, the following critical elements must be addressed:
I. Introduction: What is the purpose, scope, and subject of your analysis and management report? Your introduction must describe the aim of your paper,
what you are assessing, and the analysis you expect to perform.
II. Financial Principles and Reimbursement:
a) Reimbursement Strategies: What is the impact of case rates and management utilization data on pay-for-performance incentives? Be sure to
provide support for your response.
b) Reimbursement Methods: Analyze reimbursement methods, describing the advantages and disadvantages of each method in terms of strategic
planning for operational performance. For example, why might one method be more advantageous than another at a hospital or at a physician’s
office?
c) Financial Management Principles: Compare and contrast financial management principles such as financial data that describe financial performance
of revenue reimbursement, benchmarking of industry standards, payer-mix breakdown of payers, and case rate and utilization rate data used to
evaluate operational performance.
d) Accounts Receivable: What are the challenges associated with collecting payments for the accounts receivable or collections department, and what
is the significance of monitoring cash flow and days in accounts receivable in terms of reimbursement?
e) Teamwork Principles: Compare and contrast collaborative teamwork principles to most effectively develop strategic planning that involves crossdisciplinary teams. In other words, what principles work best for teams where individuals are from both clinical and non-clinical departments? What
are some of the challenges this might present for cohesive collaboration? Be sure to provide support for your response.
f) Maximizing Reimbursement: Generally speaking, to what extent do you feel healthcare organizations utilize case rates and management utilization
to maximize reimbursement from both government and third-party payer payment systems? Be sure to provide support for your response.
III. Federal and State Payment Systems:
a) Federal and State Regulations: Considering the recent changes in economic policy at the federal and state levels, what changes in federal and state
regulations present the most concern for healthcare leaders? Be sure to provide support for your response.
b) Reporting Requirements: Analyze the reporting guidelines required by Medicaid and Medicare and other government payment systems. What are
the opportunities and challenges for healthcare leaders in meeting reporting requirements?
c) Compliance Standards and Financial Principles: Analyze how healthcare organizations in general utilize financial principles to ensure compliance
with government standards.
d) Government Payer Types: Considering Medicaid, Medicare, and other government payer systems, what strategies would you recommend
organizations implement in order to receive full reimbursement on claims as well as to improve timeliness of this reimbursement? Be sure to justify
your recommendations.
IV. Third-Party Payment Systems:
a) Healthcare System Reimbursement: Evaluate third-party payer models for the impacts they present on healthcare system reimbursement.
b) Reporting Requirements: Analyze the reporting guidelines of third-party payer payment systems. What opportunities and challenges do they
present for healthcare leaders in meeting reporting requirements?
c) Compliance Standards and Financial Principles: Analyze how healthcare organizations in general utilize financial principles to guide strategic
planning to ensure the meeting of third-party submission requirements.
d) Reimbursement Methods: Considering third-party payer systems, what strategies would you recommend organizations implement in order to
receive full reimbursement on claims as well as to improve timeliness of this reimbursement? Be sure to justify your recommendations.
V. Operational and Strategic Planning in Healthcare:
a) Pay-For-Performance Incentives: Based on your prior analysis of the impact of case rates and management utilization data on pay-for-performance
incentives, recommend appropriate operational strategies to improve performance measures that will maximize reimbursement. Be sure to provide
support for your recommendations
b) Operational Performance Measures: Considering benchmarking data, recommend performance measures that should be monitored for the purpose
of maximizing reimbursement.
c) Teamwork and Strategic Planning: Recommend collaborative teamwork principles that would be beneficial for healthcare strategic planning in terms
of reimbursement. Be sure to provide support for your recommendations.
d) Communicating Strategic Planning Across Teams: What types of tools or strategies would you recommend for communicating strategic planning
conclusions to key stakeholders, members of cross-disciplinary teams, and the rest of the organization? In other words, how would you
communicate strategic planning information to clinical vs. non-clinical staff? To administrative staff? Be sure to provide support for your
recommendations.
e) Financial and Reimbursement Strategies: Considering cash flow and days in accounts receivable of hospital and health systems, recommend
reimbursement strategies that would be appropriate for low- and high-performing health systems. Provide evidence to support your conclusion.
Milestones
Milestone One: Draft of Financial Principles
In Module Three, you will submit a 2–3-page draft of the Financial Principles and Reimbursement portion of your research and analysis. This milestone will be
graded with the Milestone One Rubric.
Milestone Two: Draft of Federal and State Payment Systems
In Module Five, you will submit a 2–3-page draft of the Federal and State Payment Systems portion of your research and analysis. This milestone will be graded
with the Milestone Two Rubric.
Milestone Three: Draft of Third-Party Payment Systems and Planning in Healthcare
In Module Seven, you will submit a 2–3-page draft of the Third-Party Payment Systems and the Operational and Strategic Planning in Healthcare portions of your
research and analysis. Submit both sections together as a single document. This milestone will be graded with the Milestone Three Rubric.
Final Submission: Analysis and Report
In Module Nine, you will submit your analysis and report in its final form addressing all critical elements in this document. In addition to applying the feedback
you have received on each section throughout the term, you will develop your introduction for your final submission of the analysis and report. This submission
will be graded with the Final Project Rubric.
Deliverables
Milestone Deliverable Module Due Grading
One Draft of Financial Principles Three Graded separately; Milestone One Rubric
Two Draft of Federal and State Payment Systems Five Graded separately; Milestone Two Rubric
Three Draft of Third-Party Payment Systems and
Planning in Healthcare
Seven Graded separately; Milestone Three Rubric
Final Submission: Analysis and Report Nine Graded separately; Final Project Rubric
Final Project Rubric
Guidelines for Submission: Your payment system and reimbursement method analysis with report to management should be 2 pages in length and should
be double-spaced in 12-point Times New Roman font with one-inch margins. All citations and references should be formatted according to current APA
guidelines. Include at least five references.