These are the 4 parts of the paper they are complete they just need to be put together with more elaborations and polished up. Prompt
You are now a supervisor within the patient financial services (PFS) department of a healthcare system. It has been assigned to you to write a white paper to
educate other department managers about reimbursement. This includes how each specific department impacts reimbursement for services, which in turn
impacts the healthcare organization as a whole. The healthcare system may include hospitals, clinics, long-term care facilities, and more. For now, your boss has
asked you to develop a publish of this paper for the healthcare personnel only; in the future, there may be the potential to expand this for other facilities.
In order to complete the white paper, you will need to choose a hospital. You can choose one that you are familiar with or create an imaginary one. Hospitals
vary in size, location, and focus. Becker’s Hospital Review has an excellent list of things to know about the hospital industry. Once you have determined the
hospital, you will need to think about the way a patient visit works at the hospital you chose so you can review the processes and departments involved.
Conduct research through articles or get information from professional organizations. Below is an example of how to begin framing your analysis.
A patient comes in through the emergency department. In this case, the patient would be triaged and seen in the emergency department. Think about what
happens in an emergency area. The patient could be asked to change into a hospital gown (think about the costs of the gown and other supplies provided). If the
patient is displaying signs of vomiting, plastic bags will be provided and possibly antinausea medication. Lab work and possibly x-rays would be done. The patient
could be sent to surgery, sent home, or admitted as an inpatient. If he or she is admitted as an inpatient, meals will be provided and more tests will be ordered
by the physician—again, more costs and charges for the patient bill. Throughout the course, you will be gathering additional information through your readings
and supplemental materials to help you write your white paper.
When publishing this white paper, bear in mind that portions of your audience may have no healthcare reimbursement experience, while others may have been
given only a brief overview of reimbursement. The goal of this guide is to provide your readers with a thorough understanding of the importance of their
departments and thus their impact on reimbursement. Be respectful of individual positions and give equal consideration to patient care and the business aspects
of healthcare. Consider written communication skills, visual aids, and the feasibility to translate this written guide into verbal training.
Specifically, the following critical elements must be addressed:
I. Reimbursement and the Revenue Cycle
A. Describe what reimbursement means to a healthcare organization. What would happen if services were provided to patients but no payments were
received for these services?
B. Illustrate the flow of the patient through the cycle from the initial point of contact through the care and ending at the point where the
payment is collected. Also identify the departments in order of importance to the revenue cycle.
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II. Departmental Impact on Reimbursement
A. Many different departments utilize reimbursement data in a healthcare organization. It is crucial the healthcare organization monitors this data.
What impact could the healthcare organization face if this data were not monitored? Describe why collecting data is required for pay-forperformance incentives.
B. Describe the activities within each department for how they may impact reimbursement. What specific data would you review in the reimbursement
area to know whether changes were necessary?
C. Identify the responsible department for ensuring compliance with billing and coding policies. How does this affect the department’s impact on
reimbursement in a healthcare organization?
III. Billing and Reimbursement
A. Analyze how third-party policies would be used when developing billing guidelines for patient financial services (PFS) personnel and
administration when determining the payer mix for maximum reimbursement. How do third-party policies impact the payer mix for
maximum reimbursement?
B. Organize the key areas of review in order of importance for timeliness and maximization of reimbursement from third-party payers. Explain your
rationale on the order.
C. Describe a way to structure your follow-up staff in terms of effectiveness. How can you ensure that this structure will be effective?
D. Develop a plan for periodic review of procedures to ensure compliance. Include explicit steps for this plan and the feasibility of enacting this plan
within this organization.
IV. Marketing and Reimbursement
A. Explain how new managed care contracts impact reimbursement for the healthcare organization. Support your explanation with concrete evidence
or research.
B. Discuss the resources needed to ensure billing and coding compliance with regulations.
C. Evaluate strategies to ensure stakeholders involved in the reimbursement process adhere to ethical standards.