Assignment on Reimbursement and Process of Reimbursement

Reimbursement
Student’s name:
Institutional:

In healthcare, each department affects the process of reimbursement. According to
Harrington (2019), the profitability of an institution is significantly impacted by the management
of reimbursement. Poor management of reimbursement leads to an increase in the billing cost
and drop in the rates of the collection, which results in the rise of accounts receivable. The
acquisition value thus becomes unholdable. Effective management within the departments
establishes a healthy relationship between the healthcare staffs and the patients as well as
ensuring a site-level control.
The billing of reimbursement is determined by the proper and timely use HCPCS/CPT codes
that produce Ambulatory Payment Classification (APC) groups (Cleverley, & Cleverley, 2017).
APC reimbursement for the organization is achieved by making sure that the departments have a
complete and accurate coding system in place. Audit check should, therefore, be conducted
regularly to check for the same. Movva, & Jani (2018), highlighted three strategies to capture
pay-for-performance rewards which are structural strategies, outcome measures and process
strategies. Structural strategies gauge the attributes of care like human resources, material
resources and the structure of the organization. It entails the involvement of information
technology (IT) to aid care in the clinical area. The process measure takes into consideration the
procedures such as test, surgeries, involved in providing care. The CMS, private payers and third
parties routinely receive these measures in order to aid in report cards preparation. This measure
also gauges the accuracy, timeliness, appropriateness and the complications of therapy given.
Outcome strategies measure the results of the whole process of care and are also used to follow
up patient's satisfaction with their care (Harrington 2019)
The reimbursement process is the same across all the departments. It involves finding the
insurance data and verifying the patient eligibility at the front-end as well as collecting the co-