HCM 345 5-1 Milestone Two Healthcare Reimbursement

Overview: Much of what happens in healthcare is about understanding the expectations of the many departments and personnel within the organization. Reimbursement drives the financial operations of healthcare organizations; each department affects the reimbursement process regarding timelines and the amount of money put into and taken out of the system. However, if departments do not follow the guidelines put into place or do not capture the necessary information, it can be detrimental to the reimbursement system.

An important role for patient financial services (PFS) personnel is to monitor the reimbursement process, analyze the reimbursement process, and suggest changes to help maximize the reimbursement. One way to make this process more efficient is by ensuring that the various departments and personnel are exposed to the necessary knowledge.

Milestone One provides you an opportunity to engage with real-world data that you would encounter in an actual professional environment. Specifically, you will take a closer look at how reimbursement impacts other healthcare departments, and you will dive deep into analyzing the revenue cycle, utilizing data, tracking records, and ensuring compliance within individual departments.

Prompt: Submit a draft of Sections I and II of the final project. Specifically, the following critical elements must be addressed:

1. Reimbursement and the Revenue Cycle
   1. Describe what reimbursement means to a healthcare organization. What would happen if services were provided to patients but no paymentswere received for those services?
   2. 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 paymentis collected. Also identify the departments in order of importance to the revenue cycle.
2. Departmental Impact on Reimbursement
   1. Describe the impact of the departments in a healthcare organization that utilize reimbursement data. What type of audit would be necessary todetermine whether the reimbursement impact is reached fully by these departments? How could the impact of these departments on pay-for-performance incentives be measured?
   2. Assess the activities within each department in a healthcare organization for how they may impact reimbursement. What specific data wouldyou review in the reimbursement area to know whether changes were necessary?
   3. Identify the responsible department for ensuring compliance with billing and coding policies. How does this affect the department’s impact onreimbursement in a healthcare organization?