BILLING AND MARKETING REIMBURSEMENT 8
Billingand Reimbursement and Marketing and Reimbursement
Billingand Reimbursement and Marketing and Reimbursement
Billingand reimbursement forms a critical component in any healthorganization and their effectiveness depends on the quality of datacollected by each department. Similarly, marketing and reimbursementalso have a significant role especially when there are new managedcare contracts. Therefore, the research paper concentrates on datacollection, third-party policies and developing of billingguidelines, the main areas of review, structuring of follow-up-staffand a plan for periodic review. Additionally, the paper discussedvarious strategies employed during the negotiation of new managedcare contracts, the role of staff in managed care contracts, theeffect of new managed contracts on reimbursement and resourcesrequired to ensure billing and coding compliance with regulations andethical standards.
III.Billing and Reimbursement
DataCollection by Patient Access Personnel and Its Importance to Billingand Collection Process
JacksonMixon, & Abecassis, (2017), suggested that patientaccess personnel play a critical role within the healthcare systems,and they are responsible for cash collection, registration, andinsurance verification among others. Data collection is an imperativeprocedure that requires careful consideration in the planning of aregistry. Hence data can be collected by patient access personnelthrough patients, available information reported by clinicians,ancillary stores, and medical records. Therefore, the informationcollected by patient access personnel is very significant in billingand collection process as it ensures all information required forreimbursement are available. Similarly, exceptional customer servicehas the following importance: enhance buying experience, and improvesbrand’s social reputation(Jackson et al., 2017).
HowThird-Party Policies Would Be Used When Developing Billing Guidelinesfor Patient Financial Services (PFS) Personnel
Accordingto Jackson et al. (2017), third-partypolicies can be utilized when creating billing guidelines forpatients service (PFS) personnel since they provide vital servicesthat can influence the solvency and stability of healthcare system.Third-party policies can be used by health care providers especiallywhen processing claims by applicable statutes and regulations.Through third-party policies, the billing companies can consult withhealthcare providers on how to provide accurate and timely issuerelated to reimbursement. Similarly, third-party policies can beimplemented to eliminate healthcare fraud and abuse that are linkedwith patient financial services personnel. Hence, third-partypolicies play a significant role when developing billing guidelinesfor patient financial service personnel (Jacksonet al., 2017).
KeyAreas of Review in Order of Importance for Timeliness andMaximization of Reimbursement from Third-Party Payers
Thefollowing are key areas that will ensure that there are effectivetimeliness and maximization of reimbursement from third-party payers.First, it begins with patient access since they are the new payers inthe case of any eventuality. Secondly, denials must be minimal withaccurate information, by ensuring that there is correct demographicinformation that will help hospitals to be paid faster (Jacksonet al., 2017).Thirdly, utilization of eligible tools will help the staff toestablish if the patient is associated with coinsurance, insurance,copayment commitments among other. Similarly, increasing visibilityinto patient responsibility is another area that can help in themaximization of reimbursement from the third party. That is becausewhen the hospital adopted user-friendly patient responsibilitydashboards that permit registrar to view financial responsibilitythat can determine whether to request for a portion up front. Otherareas for consideration include monitoring patients’ propensity topay, collection before the instance of care and employing financialtriage strategies that maximize payments (Jacksonet al., 2017).
Howto Structure Follow-Up-Staff regarding Effectiveness
Follow-upis an imperative activity within the healthcare systems and for themanagement to maximize reimbursement, there must be a well-developedstructure that guides the staff. During the follow-up, the staff mustfocus on matters that they can achieve within a minimum period.Secondly, staff must be allocated adequate time for every essentialtask that is assigned to them(Lee et al., 2016).Additionally, it is imperative to include contingency time for anyeventuality that might occur during the follow-up. Similarly, staffsneed to be given a number of patients who they can easily manage andhandle. Duties need to be given according to the individualcapability and career goals. That structure will ensure thatfollow-up-staff are not over burden with duties and that will improvetheir effectiveness (Leeet al., 2016).
APlan for Periodic Review of Procedures to Ensure Compliance
Thediagram below outlines a plan that can be utilized for periodicreview of procedures to ensure compliance.
Internalmonitoring of the organization and auditing
Executingcompliance and institutional standards by coming up with writtenstandards and procedures
Descriptionof a compliance officer
Preformingeffective education and training
Evaluatingdetected issues and creating corrective plan
Designingopen lines of communication
Implementingdisciplinary measures through well-printed guidelines
IV.Marketing and reimbursement
StrategiesUsed To Negotiate New Managed Care Contracts
Cutlip& Kramer (2016), negotiationis very crucial, and it helps to strike a deal that is profitable forthe parties involved and such situation can also take place withinthe healthcare system when there is a new managed care contract.Similarly, there are four ways that can be utilized when negotiatinga new managed care contracts that include yielding, compromisingcompeting, and problem-solving. Yielding is a form of negotiationstrategy where one party accept the first offer, or they can assumethat the price is fixed. On the other hand, compromising is wherethe part resolves their issue and come up with a fair balance andeveryone gets an equitable deal. Alternatively, competing strategyrefers to a situation where one party wants to benefit more ascompared to another party. Finally, the problem-solving strategyfocuses on respect for both parties and negotiation is based on theprinciple of working together to make a profit(Cutlip & Kramer, 2016).
Roleof Each in Managed Care Contracts
Duringnegation of managed care contracts, there is individual who can helpin the entire process since the information they have can help indeveloping a conclusion. For instance, patient financial servicespersonnel have all the information concerning the patients and thatcan significantly contribute during negations. Similarly, financemanager also needs to be present as they understand the financialposition of the hospital and they can help to predict any implicationthat can result from managed care contracts (Cutlip& Kramer, 2016).
HowNew Managed Care Contracts Impact Reimbursement for the HealthcareOrganization
Ernst& Rouse (2016), claims that managedcare contract provides an integral financing and delivery system thatcomprises of coordinated chronic care and preventive care for themembers. Managed care contracts ensure that there is timelyprocessing of payments and that ensure continuity of healthorganization. Similarly, they ensure they update all covered healthencounter claims, and make sure that the health procedures werecapable of monitoring an individual entire healthcare experience.Therefore, new managed care contracts have impacted reimbursementprocess positively by ensuring there is a smooth transition duringthe processing period(Ernst & Rouse, 2016).
ResourcesNeeded To Ensure Billing and Coding Compliance with Regulation andEthical Standards
Thereare numerous resources that are required to ensure that billing andcoding compliance with regulations and ethical standards. First,there must be a program oversight who acts as the focal point ofevery compliance activities that is taking place in the organization.Similarly, there must be education and training where the staffs areequipped with necessary skills and knowledge, and that must takeplace annually. Additionally, monitoring and auditing are anothervital resource that will ensure that billing and coding compliancewith regulations and ethical standards (Ernst& Rouse, 2016).
Billingand reimbursement forms a critical component in any healthorganization and their effectiveness depends on the quality of datacollected by each department. Similarly, marketing and reimbursementalso have a significant role especially when there are new managedcare contracts.
Cutlip,D. E., & Kramer, D. B. (2016). Value-Based Hypothesis Testing forCardiac Device Clinical Trials A Pathway for AcceleratedReimbursement Decisions. Circulation:Cardiovascular Interventions,9(5),e003627.
Ernst,C., & Rouse, P. (2016). Complexity, Tertiariness and Healthcare:Unresolved Issues of Reimbursement and Incentives. DieUnternehmung,70(3),227-247.
Jackson,H. A., Mixon, L. A., & Abecassis, M. M. (2017). Intricacies ofTransplant Physician/Surgeon Coding, Billing, and Reimbursement. InPrinciplesof Coding and Reimbursement for Surgeons(pp. 289-296). Springer International Publishing.
Lee,S. J., Abbey, J. D., Heim, G. R., & Abbey, D. C. (2016). Seeingthe forest for the trees: Institutional environment impacts onreimbursement processes and healthcare operations. Journalof Operations Management.