IV. Third-Party Payment Systems:
1. a) Healthcare System Reimbursement: Evaluate third-party payer models for the impacts they present on healthcare system reimbursement.
Third-party payment has had a major impact in healthcare system through the aspect of increased demand and in so doing driven up prices. In particular, medical suppliers that deal with comparatively low levels of third-party payment have experienced considerably lower price upsurges in the course of time. The Patient Protection and Affordable Care Act (PPACA) has augmented the practice of high-deductible insurance, but has other features that work against cost suppression and control. In addition, the third-party payer models have also facilitated faster and easier payment practices for healthcare services rendered (Buff and Terrell, 2014).
2. b) Reporting Requirements: Analyze the reporting guidelines of third-party payer payment systems. What opportunities and challenges do they present for healthcare leaders in meeting reporting requirements?
There are opportunities presented to healthcare leaders is that there is the ability of fast, comprehensive assessment of prospective misconduct of corporate officers who can influence billing decisions. There is the quick detection as well as reporting and this diminishes the loss incurred by third-party payers from false claims. In addition, it is possible to augment the structure of the billing of the corporation’s operations and consistency between different business units. There are also challenges that come about. One of the challenges takes into account the fear and hesitation be personnel in reporting any issues and problems that come about. In addition, having a centralized system can limit the effectiveness of the payment systems in different units (Office of Inspector General, 1998).
3. 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.
One of the ways is to ensure that the...
References
Buff, M. J., & Terrell, T. D. (2014). The role of third-party payers in medical cost increases. Journal of American Physicians and Surgeons, 19(2).
Leebov, W. (2017). Team Collaboration and Communication: Engaging Non-Clinical Employees Who Don’t Deal Directly with Patients. Language of Caring. Retrieved from: http://www.languageofcaring.com/resource/team-collaboration-and-communication-engaging-non-clinical-employees-who-dont-deal-directly-with-patients-2/
McKesson. (2017). The Pay for Performance Model of Healthcare Reimbursement. Retrieved from: http://www.mckesson.com/population-health-management/resources/pay-for-performance-model/
Nancarrow, S. A., Booth, A., Ariss, S., Smith, T., Enderby, P., & Roots, A. (2013). Ten principles of good interdisciplinary team work. Human resources for Health, 11(1), 19.
Office of Inspector General. (1998). Compliance Guidelines. Retrieved from: https://oig.hhs.gov/fraud/docs/complianceguidance/thirdparty.pdf
Olsen, L., Saunders, R. S., & Yong, P. L. (Eds.). (2010). The healthcare imperative: lowering costs and improving outcomes: workshop series summary. National Academies Press.
Perera, F. D. P. R., & Peiró, M. (2012). Strategic planning in healthcare organizations. Revista Española de Cardiología (English Edition), 65(8), 749-754.
Porter, M.E., Lee, T. H. (2013). The Strategy That Will Fix Health Care. Harvard Business Review.
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