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.
For your final project, you will assume the role of a supervisor within a PFS department and develop a white paper in which the necessary healthcare
reimbursement knowledge is outlined.
The project is divided into two 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 and Five.
In this assignment, you will demonstrate your mastery of the following course outcomes:
• HCM-345-01: Analyze the impacts of various healthcare departments and their interrelationships on the revenue cycle
• HCM-345-02: Compare third-party payer policies through analysis of reimbursement guidelines for achieving timely and maximum reimbursements
• HCM-345-03: Analyze organizational strategies for negotiating healthcare contracts with managed care organizations
• HCM-345-04: Critique legal and ethical standards and policies in healthcare coding and billing for ensuring compliance with rules and regulations
• HCM-345-05: Evaluate the use of reimbursement data for its purpose in case and utilization management and healthcare quality improvement as well
as its impact on pay for performance incentives