Essay
Overview: Hospital administrators review accounts receivable schedules and reports to determine how much revenue is being received from various sources (i.e., Medicaid, Medicare, Anthem, self-pay from patients, and other third-party payers). Revenue from various sources is referred to as the organization’s “payer mix.” In this milestone, you will examine operational and strategic planning in healthcare and consider selecting the three elements that you feel will be most important to complete in terms of receiving feedback.
Prompt: Submit a draft of the Third-Party Payment Systems and the Operational and Strategic Planning in Healthcare portions of your research and analysis.
Specifically, the following critical elements must be addressed:
IV. Third-Party Payment Systems:
a) Healthcare System Reimbursement: Evaluate third-party payer models for the impacts they present on healthcare system reimbursement.
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?
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.
d) Reimbursement Methods: Considering third-party payer systems, what strategies would you recommend organizations implement in order to receive full reimbursement on claims as well as to improve timeliness of this reimbursement? Be sure to justify your recommendations
V. Operational and Strategic Planning in Healthcare:
a) Pay-For-Performance Incentives: Based on your prior analysis of the impact of case rates and management utilization data on pay-forperformance incentives, recommend appropriate operational strategies to improve performance measures that will maximize reimbursement. Be sure to provide support for your recommendations.
b) Operational Performance Measures: Considering benchmarking data, recommend performance measures that should be monitored for the purpose of maximizing reimbursement.
c) Teamwork and Strategic Planning: Recommend collaborative teamwork principles that would be beneficial for healthcare strategic planning in terms of reimbursement. Be sure to provide support for your recommendations.
d) Communicating Strategic Planning Across Teams: What types of tools or strategies would you recommend for communicating strategic planning conclusions to key stakeholders, members of cross-disciplinary teams, and the rest of the organization? In other words, how would you communicate strategic planning information to clinical vs. non-clinical staff? To administrative staff? Be sure to provide support for your recommendations.
e) Financial and Reimbursement Strategies: Considering cash flow and days in accounts receivable for hospital and health systems, recommend reimbursement strategies that would be appropriate for low- and high-performing health systems. Provide evidence to support your conclusion
Guidelines for Submission: Your draft of the third-party payment systems and the operational and strategic planning in healthcare portions of your research and analysis should be 2–3 pages in length and should be double-spaced in 12-point Times New Roman font with one-inch margins, in a single Microsoft Word document. All citations and references should be formatted according to current APA guidelines. Include at least two references.
Rubric for assignment is attached below.
IHP 630 Milestone Three Guidelines and Rubric
Overview: Hospital administrators review accounts receivable schedules and reports to determine how much revenue is being received from various sources
(i.e., Medicaid, Medicare, Anthem, self-pay from patients, and other third-party payers). Revenue from various sources is referred to as the organization’s “payer
mix.” In this milestone, you will examine operational and strategic planning in healthcare and consider selecting the three elements that you feel will be most
important to complete in terms of receiving feedback.
Prompt: Submit a draft of the Third-Party Payment Systems and the Operational and Strategic Planning in Healthcare portions of your research and analysis.
Specifically, the following critical elements must be addressed:
IV. Third-Party Payment Systems:
a) Healthcare System Reimbursement: Evaluate third-party payer models for the impacts they present on healthcare system reimbursement.
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?
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.
d) Reimbursement Methods: Considering third-party payer systems, what strategies would you recommend organizations implement in order to
receive full reimbursement on claims as well as to improve timeliness of this reimbursement? Be sure to justify your recommendations.
V. Operational and Strategic Planning in Healthcare:
a) Pay-For-Performance Incentives: Based on your prior analysis of the impact of case rates and management utilization data on pay-for-
performance incentives, recommend appropriate operational strategies to improve performance measures that will maximize reimbursement.
Be sure to provide support for your recommendations.
b) Operational Performance Measures: Considering benchmarking data, recommend performance measures that should be monitored for the
purpose of maximizing reimbursement.
c) Teamwork and Strategic Planning: Recommend collaborative teamwork principles that would be beneficial for healthcare strategic planning in
terms of reimbursement. Be sure to provide support for your recommendations.
d) Communicating Strategic Planning Across Teams: What types of tools or strategies would you recommend for communicating strategic planning
conclusions to key stakeholders, members of cross-disciplinary teams, and the rest of the organization? In other words, how would you
communicate strategic planning information to clinical vs. non-clinical staff? To administrative staff? Be sure to provide support for your
recommendations.
e) Financial and Reimbursement Strategies: Considering cash flow and days in accounts receivable for hospital and health systems, recommend
reimbursement strategies that would be appropriate for low- and high-performing health systems. Provide evidence to support your conclusion.
Rubric
Guidelines for Submission: Your draft of the third-party payment systems and the operational and strategic planning in healthcare portions of your research and
analysis should be 2–3 pages in length and should be double-spaced in 12-point Times New Roman font with one-inch margins, in a single Microsoft Word
document. All citations and references should be formatted according to current APA guidelines. Include at least two references.
Critical Elements Proficient (100%) Needs Improvement (70%) Not Evident (0%) Value
Third-Party
Payment:
Reimbursement
Accurately evaluates third-party payer
models for the impact they present on
healthcare system reimbursement
Evaluates third-party payer models for
the impact they present on healthcare
system reimbursement but with gaps
in accuracy or detail
Does not evaluate third-party payer
models for the impact they present on
healthcare system reimbursement
10
Third-Party
Payment: Reporting
Requirements
Accurately analyzes reporting
guidelines required by third-party
payer payment systems for the
opportunities and challenges facing
healthcare leaders in meeting
reporting requirements
Analyzes reporting guidelines required
by third-party payer payment systems
for the opportunities and challenges
facing healthcare leaders in meeting
reporting requirements but with gaps
in accuracy or detail
Does not analyze reporting guidelines
required by third-party payer
payment systems for the
opportunities and challenges facing
healthcare leaders in meeting
reporting requirements
10
Third-Party
Payment:
Compliance
Standards
Accurately analyzes how healthcare
organizations utilize financial
principles for guiding strategic
planning in ensuring compliance with
third-party payer submission
requirements
Analyzes how healthcare
organizations utilize financial
principles for guiding strategic
planning in ensuring compliance with
third-party payer submission
requirements but with gaps in
accuracy or detail
Does not analyze how healthcare
organizations utilize financial
principles for guiding strategic
planning in ensuring compliance with
third-party payer submission
requirements
10
Third-Party
Payment:
Reimbursement
Methods
Recommends appropriate strategies
for organizations to receive full
reimbursement on claims and
improve timeliness of reimbursement
from third-party payer systems,
justifying recommendations
Recommends strategies, but they are
not appropriate for organizations to
receive full reimbursement on claims
and improve timeliness of
reimbursement from third-party
payer systems or response has gaps in
detail or relevant justification
Does not recommend strategies for
organizations to receive full
reimbursement on claims and
improve timeliness of reimbursement
from third-party payer systems
10
Planning: Pay-for-
Performance
Makes appropriate recommendations
for operational strategies to improve
performance measures that will
maximize reimbursement based on
prior analysis of impact of case rates
and management utilization data,
providing support for
recommendations
Makes recommendations, but they
are not appropriate for operational
strategies to improve performance
measures that will maximize
reimbursement, recommendations
are not based on prior analysis of
impact of case rates and management
utilization data, or response has gaps
in detail or relevant support
Does not make recommendations for
operational strategies to improve
performance measures that will
maximize reimbursement
10
Planning:
Operational
Performance
Recommends appropriate
performance measures that should be
monitored for the purpose of
maximizing reimbursement,
considering benchmarking data
Recommends performance measures
that should be monitored for the
purpose of maximizing
reimbursement, but measures are not
appropriate for the intended purpose
or recommendations are not based on
benchmarking data
Does not recommend performance
measures that should be monitored
for the purpose of maximizing
reimbursement, considering
benchmarking data
10
Planning: Teamwork Recommends appropriate
collaborative teamwork principles
that would be beneficial for
healthcare strategic planning in terms
of reimbursement, providing support
for recommendations
Recommends teamwork principles,
but they are not appropriate or
adequate for the intended purpose or
response has gaps in detail or relevant
support
Does not recommend collaborative
teamwork principles that would be
beneficial for healthcare strategic
planning in terms of reimbursement
10
Planning:
Communicating
Recommends appropriate tools or
strategies for communicating strategic
planning conclusions to various
audiences, providing support for
recommendations
Recommends tools or strategies, but
they are not appropriate for
communicating strategic planning
conclusions to various audiences or
response has gaps in detail or relevant
support
Does not recommend tools or
strategies for communicating strategic
planning conclusions to various
audiences
10
Planning: Financial
and Reimbursement
Strategies
Recommends appropriate
reimbursement strategies for low-
and high-performing health systems,
considering cash flow and days in
accounts receivable, supporting
conclusion with evidence
Recommends strategies for low- and
high-performing health systems, but
recommendations are not appropriate
for the intended purpose or do not
consider cash flow and days in
accounts receivable, or response has
gaps in detail or relevant support
Does not recommend reimbursement
strategies for low- and high-
performing health systems
10
Articulation of
Response
Submission has no major errors
related to citations, grammar,
spelling, syntax, or organization
Submission has major errors related
to citations, grammar, spelling,
syntax, or organization that negatively
impact readability and articulation of
main ideas
Submission has critical errors related
to citations, grammar, spelling,
syntax, or organization that prevent
understanding of ideas
10
Total 100%