DEPARTMENTAL IMPACT ON REINBURSEMENT 6
DepartmentalImpact on Reimbursement
DepartmentalImpact on Reimbursement
Mostof the departments that are found within the healthcare systems arein one way or the other affected by the mode of reimbursementutilized. Such changes ensure that the services that are provided byphysicians to the patients are paid according to both timeliness andaccuracy. Therefore, the primary focus of the research paper is toanalyze the impact of reimbursement in various departments that arelocated within the healthcare system.
Impactof the Departments That Utilizes Reimbursement Data
Covington,McMillan & Kuo (2016), sated that Mostof the departments that utilize reimbursement data experiencesworkload and that imply that staffs are overworked. Similarly,despite the extensive work that workers are subjected to their incomeis very low and the performance of these departments is affected. For instance, in the emergency department it has been establishedthat the reimbursement ratios for outpatients are decreasing. Forthat reason, emergency department reimbursement ratio continues tofall, and that is as a result of emergency department charges thatare not paid. Moreover, that is a clear indication that emergencydepartment is experiencing financial crisis and that can have animpact on the service delivery(Covington, McMillan & Kuo, 2016).
Typeof Audit Necessary to Determine If Reimbursement Is Reached Fully InDepartment
Theaudit is a practice that is applied in numerous organizationsespecially by the health professionals to ensure that they evaluate,assess and improve the care of patients in a systematic manner(Covington,McMillan & Kuo, 2016).The audit is very significant since it can be used to measure thecurrent practice against a specific estimated standard to determineif reimbursement in departments were fully reached. Hence, the typeof audit that is necessary for assessing if reimbursement is reachedfully in the health department is a financial audit. The financialaudit is very important when addressing reimbursement issues since itcan help to evaluate question-related to recording, accounting, andreporting of financial transactions (Covington,McMillan & Kuo, 2016).
Howthe Impact of These Departments on Pay-For-Performance Incentives AreMeasured
Pay-for-performancein healthcare departments refers to the payment systems that areimplemented to meet financial rewards to staff that show tremendousperformance on specified quality and cost measures. There are threedistinct categories that can be employed to measurepay-of-performance initiatives (Covington,McMillan & Kuo, 2016).First, there is a structural measure that comprises of use ofelectronic systems, patient access to the care, patient experience ofcare and cross practice. On the other hand, there is a clinicalprocess that can be formulated to measure pay-for-performanceinitiative provided there are availability of data through the claim,decreased reporting burden to physician and breath of endorsedmeasures by the National Quality Forum (NQF). Finally, thepay-for-performance initiative can be measured by the outcome, and itdetermines the nature of productivity of every staff. The outcome canbe an indication of improved service delivery as provided by thepatients on their regular visits to the healthcare (Covington,McMillan & Kuo, 2016).
HowActivities in Each Department Impact Reimbursement
Accordingto Price,Buchsbaum, & Price (2016), Patientsare always provided with a broad range of services by healthcareprofessionals and their payment varies. Therefore, there is need todocument these services provided to the patients accurately to ensurethat the reimbursement is made appropriately. Therefore, theactivities that take place within clinical service can affectreimbursement significantly. For instance, staff within the clinicalservices documents the type of care that should be given to thepatient(Price, Buchsbaum, & Price, 2016).Within this department, there must be accurate keeping of recordsevery time the patient visits the hospital. As a result, when thedocument kept by this department are not correct, the patient may notobtain services in time, and that can also lead to delayed payments.Additionally, if the records are not accurate, the patient can beforced to pay for services offered directly from their pockets(Price,Buchsbaum, & Price, 2016).
DepartmentResponsible For Compliance with Billing and Coding Policies
Thedepartment that is responsible and ensures compliance with billingand coding policies within the healthcare system is the financedepartment. Within the finance department, there are individuals whoare specialized in billing and coding, and they handle very sensitiveinformation on a daily basis (Lang,2016).Similarly, these specialists handle the patient, service providersand insurance information that must be kept secure. Additionally,they facilitate the transfer of information between these partiesboth through electronic and physical forms. For smooth operation ofthe department, finance department must ensure that there is fullcompliance with billing and coding policies in the healthcare system(Lang, 2016).
HowBilling and Coding Affect Department on Reimbursement
Billingand coding have a significant role as far as reimbursement isconcerned and when there is integrity in handle all information thenreimbursement will be made for any service offered (Lang,2016).On the other hand, when billing and coding are not handled accordingto the rules and regulation, there are many implications that canresult when reimbursement are to be made. Some of the unethicalpractices that can result in such situation include upcoding.Upcoding is whereby the providers assign a higher CPT/ICD9 to statethe condition of the patients, and they are not true. When suchactions are identified, they can affect the reimbursement of theservices offered (Lang,2016).
Mostof the departments that are found within the healthcare systems arein one way or the other affected by the mode of reimbursementutilized. Similarly, every department in the health care systems mustensure that their records are accurate and they are well securedsince they can affect reimbursement.
Covington,M. F., McMillan, N. A., & Kuo, P. H. (2016). Impact ofReimbursement Cuts on the Sustainability and Accessibility ofDopamine Transporter Imaging. Journalof the American College of Radiology.
Lang,A. (2016). Collaborative Governance in Health and Technology PolicyThe Use and Effects of Procedural Policy Instruments. Administration& Society,0095399716664163.
Price,J., Buchsbaum, R., & Price, K. (2016). The Evolving Environmentfor Outpatient Hospital Services: Medicare’s Site-NeutralReimbursement for New Off-Campus Locations.