Third-Party Payment Systems:
a) Healthcare System Reimbursement: Evaluate third-party payer models for the impacts they present on healthcare system reimbursement.
Third-party payer models currently have a tremendous impact on the healthcare reimbursement system. The most considerable of these is the diverse forms in which they cause reimbursement to manifest. The vast majority of patients involved in the healthcare system utilize third-party payer models in the form of healthcare insurance. Insurance companies are the predominant means of reimbursing healthcare organizations for the services they provide, the equipment they use, and the staff they employee. In a sense these insurance companies are reimbursed by the premiums they exact from their patients. These two aspects of reimbursement make this concept multidimensional, which is the main effect of third-party payer models on healthcare system reimbursement.
b) Reporting Requirements: Analyze the reporting guidelines of third-party payer payment systems.
There are several challenges and opportunities for third-party payers regarding reporting guidelines for their payment systems. The most substantial challenge is to have payment data integrated, accessible, and available for reports in an expedient time frame to increase transparency within organizations and throughout this industry (Disparte, 2017). The tendency of most organizations is to build data silos for each regulatory report. Those that are able to meet this challenge with an integrated form of organizing and storing such data are able to gain an opportunity to reuse this data for additional reports. Thus, the opportunity then becomes one based on decreasing time to action by simply reusing data pertinent for multiple reports. Additional challenges are related to successfully protecting such data with established governance policies and security measures.
c) Compliance Standards and Financial Principles: Analyze how healthcare organizations in general utilize financial principles to guide strategic planning to ensure the meeting of third-party submission requirements.
There are a couple of basic staples of financial principles which healthcare organizations routinely leverage to guide strategic planning to meet third-party submission requirements for regulatory compliance. The most eminent is maintaining a propitious balance between revenues and expenses. Preserving such a balance is a critical facet of operations and an area in which the former regularly intersects with...
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