Reimbursement Analysis 2022

Reimbursement
Name of student
Name of institution
Date
Author’s note

Reimbursement
Iii. Billing and Reimbursement
The collection of data by the patient access personnel play a very significant role in the
billing and collection process. The patient access personnel acts as a link between the patient and
the insurance company. In addition, a facility that has excellent customer service also stands a
better chance of improving the data collection process. Third party policies are used in
developing guidelines for patient financial services (PFS) personnel. Third party policies ensure
that the patient’s privacy is maintained. They can also be used in deterring the payer mix to
ensure maximum reimbursement (Fontenot, 2018).
The key areas of review are data collection, analysis, reevaluation, implementation and
follow up. These areas have been arranged for maximization of reimbursement from third party
payers. The rationale behind this is to ensure a systemic process that will be efficient. Follow up
can be structured by conducting the process using staff who were in the reviewing process. To
ensure that the structure is effective, each member will be delegated a duty. This initiative will
foster a sense of belonging and purpose (Wright, 2017).
The periodic review of procedures will be done twice a year to ensure compliance. The
plan will begin by analyzing the current procedure. Research will then be conducted to determine
if there are new evidence-based procedures that can be implemented. The procedure will be
reevaluated, and appropriate changes will be made. Follow up on implementation will be done
Iv. Marketing and Reimbursement
there are various strategies that are used to negotiate new managed care contracts. The
most common strategies are collaborative negotiation. This is where both parties end up with a

win. Occasionally, a compromising strategy is used. In this strategy, both parties negotiate and
split up the win so that both parties can win. Every individual in the healthcare organization
plays a significant role in the context of managed care contact. The accountants are responsible
for billing process, the sales are responsible for finding clients, the managers are the final
decision makers and the healthcare workers implement the contents of the contract (Boone,
2019).
New managed care contracts impact the reimbursement for the healthcare organization
because they introduce new methods and systems that should be implemented. In addition, some
contracts may introduce new services the hospital may require developing a billing process.
According to evidence-based research new managed care contracts can either result in significant
improvement in the facility or can destroy the organizational structure of the facility
There are various resources that are used to ensure that the billing and coding process is
following the ethical standards. The first resource is working with competent employees who are
accredited. Another resource is the code of ethics; this is a guideline that dictates how
professional duties should be conducted. If these resources were not obtained, the organization
will be liable for noncompliance. If this occurs, the organization could be shut down or could
face monetary payment. The license of the organization can be revoked (Crumley, Lloyd,
Pucciarello & Stapelfeld, 2018).

References
Boone, J. (2019). Health provider networks with private contracts: Is there under-treatment in
narrow networks?. Journal of health economics, 67, 102222.
Crumley, D., Lloyd, J., Pucciarello, M., & Stapelfeld, B. (2018). Addressing social determinants
of health via Medicaid Managed Care contracts and Section 1115 demonstrations. Center
for Health Care Strategies. https://www. chcs. org/media/Addressing-SDOH-Medicaid-
Contracts-1115-Demonstrations-121118. pdf. Published December.
Fontenot, M. G. (2018). U.S. Patent No. 10,121,192. Washington, DC: U.S. Patent and
Trademark Office.
Wright, K. (2017). Revenue Cycle and Reimbursement. Health Information Management:
Principles and Organization for Health Information Services.