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Health careIrish BrewtonSouthern New Hampshire HCM 34511/30/2016Health careBilling and ReimbursementImportance of patient data In the health care, it is very important to collect patient data so that their records can be kept. It is true that the data can be used in the government level, to show how the health care is running and to give the number of patients which attend the unit over a given place. In addition, the data is important to different stakeholders of the industry in helping to improve services. For instance, by knowing the number of people who attend the place over a given time, the government will be aware of how much is to be contributed and what kind of resources are to given. Customer service is also analyzed from the customer data, so that it is clear whether they are being treated in the right way or whether they are getting their rights.How third party policies will be used in funding There are two types of revenue providers when it comes to patient services. There are some who are internal providers while others are external providers. In all these cases, there are some factors which are looked at, such as: the activity of the provider. In fact, the profession of the provider is very important in determining how he or she will provide for patient services. In the second place is patient volume, and the number of patients who attend a given hospital, in which case if the number of patients is high, the funding will also be high and vice versa. The third factor is the fees which are charged for the services; when it is high, funding is also increased and vice versa (Casto, 2013). Further, the insurance claims are also considered, the patient payments and the collections which are made from other partners and well –wishers.Key areas of review In reimbursement of funds, the first thing which is looked at is the numbers of patients which are handled over a specific time. This means that if so many people are being attended to in a given health center, then that health center will receive more funds that the one which is attending less number of patients. In addition, the level of the health center is also important. The starting health centers are given more resources so that they can become independent, while those which are independent are given fewer funds, because they have already stabilized.How to structure staffs for effectiveness In order to make sure that there is effectiveness in the health center, there has to be division of labor. Each staff is going to be given his own responsibility which he or she is to do within a given time, and during this time, there has to be complete recording of everything which happens in the department. This will help the administration to make up follow-ups, and so that every staff can be responsible of their own actions. In addition, the staffs are to report directly to the head of department for the time they are on duty, so that they can be easily tracked.A plan for periodic review of procedures to ensure compliance Creation of the plan follows the following steps:Conducting internal monitoring and auditing through the performance of periodic audits. This is meant to know what the health care units are doing and which the best ways of addressing the problems which are arising in the industry are.Implementing compliance and organizational standards through the development of written standards and procedures; which is very important in analyzing the written reports in the health care unit. In addition, the written standards will set the codes of conduct and will ensure that the system is running in the expected way. Designation of a Compliance Officer and other personnel who will be responsible for given works in the system, with an ultimate goal of satisfy the needs of patients.Marketing and ReimbursementThe strategies used to negotiate new managed care contracts In order to negotiate new managed contracts, there are some factors which are required such as:There is setting of the goals from the relationship, so that the health care organization will know what direction they are to take.Looking beyond the rates (Fisk, 2012). It is important to look at what rates are being offered, but then, it is also very important to look at the interest of the payer and how much they impact the organization.Addressing more than just the hospital; the management has to make sure that they are doing more around the communities they are operating at. For instance, apart from just treating people, they can also provide community awareness on the prevention of different illnesses.Development of the payer profiles, which are meant to help the payer understand that there is something they are going to gain from the services and contracts.Keeping options open, so that the stakeholders, contractors and payers can negotiate terms.Lastly, it will be better for the management to discuss starters, so that they are able to know where they should begin and which thing they should add or do away with, before the system begins any implementation.The important role that each individual within this healthcare organization plays In the creation of contracts, each party has a role to play in the healthcare organizations. For instance, the payers are the ones who will provide the funds which will be used in developing the health care services. On the other hand, the health care management are supposed to come up with a plan on how the funds will be utilized. The government also endorses the rules which are to limit the standards of the health care facilities. The patients will be the beneficiaries of the funds, and they also have a role of paying a given rate of payables so that the health care organization can be improved.How new managed care contracts impact reimbursement for the healthcare organization The new managed care contracts are known to increase competition in the health care organizations in the industry and may even change the structure of the health care delivery. In addition, it can be aid to have changed the physician practice patterns. In fact, it is clear that the new managed contracts have been related to lower rates of hospital costs inflation, because most funds are given by payers. The physical practice is known to have improved, so as to match with the stiff competition which is coming up. There also have been changes relating to hospital capacity which has relatively increased, hospital admission patterns, the size and the composition of the staff work force as well as the adoption of the use of medical equipment and technologies. All these are aimed at offering satisfaction to the patients and increase the profitability of the organization (McWay, 2013).Resources needed to ensure billing and coding compliance with regulations Resources needed to ensure billing and coding compliance with regulations and ethical standards;There are coding resources which are responsible for telling the codes which are set in an organizationPractice resources, which are also helpful in showing the practices of a given organization and the health way to run an organization.Accuracy billing resources, which show the way funds were received and how they were used, and they are also very helpful in determining the financial health of an organization.Medical records can also be said to be resources which help in tracking the progress of patients and any other thing in the healthcare organization.In the case where these resources are missing, there will be a great difficulty in determining the workability of the organization, the progress of patients and even the financial progress of the organization.ReferencesCasto, A. B. (2013). Principles of Healthcare Reimbursement. American Health Information Management Association, 2013.Fisk, R. (2012). Top Managed Care Contracting Clauses: A Tool-kit for Providers. Hcpro Incorporated, 2012.McWay, D. C. (2013). Today's Health Information Management: An Integrated Approach. Cengage Learning, 2013.
Solution: Billing In A Bundle