Free Essay: Healthcare System Reimbursement

Third-party payer models such as Medicaid and Medicare play a vital role in the healthcare industry. To begin with, they enable many people to afford treatment charges and so the hospitals will always be full in most cases. This means that additional medics will be required now and then to cater to a large number of patients.

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Reporting Requirements

Highly effective reporting requirements are implemented to enable smooth operations and excellence. The strategies are tremendously beneficial to healthcare managers as they can always see the true picture of their financial performance with third-party payment systems. The requirements enable transparency and reliability and the information obtained can be used to make huge and well-informed changes in the healthcare system (Serbin Medical Billing, 2020). Their major challenge is that they are tedious and can be easily messed up. Correspondingly, a huge loss would be realized.

Compliance Standards and Financial Principles

Hospitals often adhere to financial principles that embrace quality care, respect, compassion, and dignity to meet the operational standards set by the government. The major financial principles that they have to observe include timeliness, consistency, materiality, prudence, and reliability. Managers are urged to be accountable and transparent at all times. Accurate data accompanied with a well-detailed explanation ought to be provided to the public for better understanding and development of trust.

Reimbursement Methods

Public health insurance covers such as Medicaid and Medicare tend to delay payment and so healthcare managers have to come up with better ways of receiving their payments in time. I suggest that medics should make medical claims quickly and early enough to enable timely reimbursement. All financial reporting systems should be efficient and updated to avoid delays and other inefficiencies (Behrendt et al., 2017). Medical staff should record accurate data and present them for auditing before reimbursement. Besides, they can seek consent and give waivers to the clients for easy compliance and cooperation.

Operational & Strategic Planning in Healthcare

Pay-For-Performance Incentives

Treatment charges should only be based on the services received by the patient. Patients should only pay for the procedures they undergo and improve their health. Insurance firms should also be capable of covering the entire cost of treatment for them to be considered effective. Additionally, the value-reimbursement method, which emphasizes on the quality of care provided should be utilized (Brealey, Myers, Allen, & Mohanty, 2018). The technique ensures that medics are only compensated for a remarkable job, and not just attending to a patient without being concerned about their recovery.

Operational Performance Measures

Financial records must be evaluated and performance monitored keenly to curb any potential hindrance to effective benchmarking. Auditing should be done regularly to identify areas of strength and weakness and propose means of moving forward. Patient’s records such as the amount of time they have to wait before receiving service, improved outcomes, and ease of access to service should be monitored and stored electronically for future analysis.

Teamwork and Strategic Planning

Tested and highly workable collaborative teamwork principles ought to be adopted to enable strategic healthcare planning. Healthcare providers must work as a team to avoid disagreements on billing and standards of services. They need to understand and appreciate each other’s work to develop a healthy working relationship (Maryville University, 2020). Moreover, they should implement policies of working as a team to prevent minor conflicts at any given time. Working as a team also require medics to be supportive of one another. Instead of criticizing the flaws of a given team member/department, the entire crew should come in the aid of the affected member to restore their productivity.

Communicating Strategic Planning Across Teams

Communication is paramount for the success of any organization. Strategic plans should be developed by administrative staff during seminars and workshops where every manager is allowed to air their views and contribute towards a particular course of action. The decision made on intended implementation should then be passed to clinical staff through memos and during team-building workshops where they can be given necessary training regarding the strategy (Smith, 2020). Non-clinical stakeholders, on the other hand, should be informed of the strategic plans during annual general meetings or special general meetings, depending on the agency of implementation.

Financial and Reimbursement Strategies

Low-performing healthcare facilities do not have major needs for huge amounts of money. Therefore, their reimbursement can be done annually based on the audits of their financial performance in the previous financial year. High-performing health systems, quite the opposite, spend a lot of money regularly to cater for operational costs and purchase of expensive equipment (NEJM Catalyst, 2018). Their financial needs shift frequently and so reimbursement should be done either monthly or quarterly, i.e., after every three months.

References

Behrendt, C., Heidemann, F., Rieß, H. C., Stoberock, K., & Debus, S. E. (2017). Registry and health insurance claims data in vascular research and quality improvement. Vasa, 46(1), 11-15. https://doi.org/10.1024/0301-1526/a000589

Brealey, R. A., Myers, S. C., & Allen F. (2018). Principles of Corporate Finance (10th ed.). McGraw-Hill Education. https://is.cuni.cz/studium/predmety/index.php?do=download&did=186638&kod=JEM034https://is.cuni.cz/studium/predmety/index.php?do=download&did=186638&kod=JEM034

Maryville University. (2020). The five benefits of teamwork in nursing | Maryville online nursing programs. Maryville Online. https://online.maryville.edu/nursing-degrees/top-5-benefits-of-teamwork-in-nursing/

NEJM Catalyst. (2018, March 1). What is pay for performance in healthcare? NEJM Catalyst - Practical Innovations in Health Care Delivery. https://catalyst.nejm.org/doi/full/10.1056/CAT.18.0245

Serbin Medical Billing. (2020). Understanding third-party Payer requirements for prompt payments to ASCs. Serbin Medical Billing: Personalized Revenue Cycle Services for ASCs. https://www.serbinmedicalbilling.com/understanding-third-party-payer-requirements-for-prompt-payments-to-ascs

Smith R. (2020, March 19). How to communicate your healthcare strategy to the department level. ClearPoint Strategy. https://www.clearpointstrategy.com/how-to-communicate-healthcare-strategy-department-level/