proposal for billing changes to pay for healthcare

proposal for billing changes to pay for healthcare

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proposal for billing changes to pay for healthcare

Question Description
Can you help me understand this Health & Medical question?

GRADING RUBRIC MUST BE FOLLOWED

Write a 3–4-page proposal for billing changes, and explain how the proposed changes will benefit the organization, the physicians, and the patients.

Questions to Consider:

What resources are available to help patients with no insurance and no financial means to pay for health care?
How can an organization be financially prepared to handle uninsured patients?
REQUIREMENTS
Imagine that you have just stepped into a new role as the office manager for a very successful clinic. The clinic is a conglomeration of physicians who offer specialized care. Each group of physicians tried to manage their own billing process but it quickly became obvious that one billing office would be more efficient. You realize that there has been a lack of consistency in the clinic and that you will need to update the billing policies and procedures immediately. You also realize that there is always resistance to change, and you will need to provide evidence supporting the changes you plan to make.

Prepare a proposal for billing changes that you would present to the physicians. You will need to support each proposed change with relevant evidence to assure buy-in from the physicians.

Write a proposal for changes you would like to make to the billing policies and procedures in a successful physicians clinic. Include the following in your proposal:

Develop a step-by-step process for the entire revenue cycle from pre-verification of insurance to accounts receivable management.
Recommend a method for determining a pricing structure. What factors can influence pricing?
Explain the factors that must be considered while negotiating insurance contracts. What major payer categories are appropriate for this practice?
Explain how the clinic will handle private pay and charity care.
Recommend either an installed or a web-based billing software system. (Please note that you should not recommend a specific brand of software; just the type of software.)
Explain how the changes will benefit the physicians, the clinic, and patients.
Resources:

Additional Resources for Further Exploration
You may use the following optional resources to further explore topics related to competencies.

Coding and Reimbursement
This website focuses on medical billing and revenue cycle management, and it has helpful links to education and publications on these topics.

Healthcare Billing and Management Association. (n.d.). Retrieved from https://www.hbma.org/.
The information on this website relates to the billing and coding process, and it provides links and information on revenue and reimbursement cycles for health care organizations.

American Academy of Professional Coders. (n.d.). Medical billing and coding. Retrieved from https://www.aapc.com/medical-billing/medical-billi…
This website provides an overview of each code set in relation to HIPAA.

Centers for Medicare & Medicaid Services. (n.d.). Code sets overview. Retrieved from https://www.cms.gov/Regulations-and-Guidance/Admin…
This website provides technical process information on aspects of ICD-10 codes, guidelines, and regulations.

Centers for Medicare & Medicaid Services. (n.d.). ICD-10. Retrieved from https://www.cms.gov/Medicare/Coding/ICD10/index.ht…
Financial Strategies
This is a bi-weekly newsletter focusing on health care finance strategies for a variety of topics. The main website contains links to publications and resources.

Healthcare Financial Management Association. (n.d.). Healthcare finance strategies. Retrieved from http://www.hfma.org/Content.aspx?id=1728
Financial Management
This web page discusses electronic exchanges between administrative and financial entities, and it contains helpful links.

Centers for Medicare & Medicaid Services. (n.d.). Transactions overview. Retrieved from https://www.cms.gov/Regulations-and-Guidance/Admin…
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proposal for billing changes to pay for healthcare

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.