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

Part 3: Third-Party Payment Systems

Healthcare System Reimbursement

This section is no longer than a half-page. Choose a third party payor (Aetna, Blue Cross, Kaiser Permananete are all big ones). Identify two impacts a third party payor has on a healthcare organization. (Why should the healthcare organization care about meeting the requirements of the third party payor?)

Reporting Requirements

This section is no longer than a page. Using the same payor, what are some items that are required to be reported to that payor? What are two opportunities (benefits for the healthcare organization and/or American health) and two challenges (concerns within the healthcare facility) for healthcare leaders in meeting the reporting requirements you described?

Compliance Standards

This section is no longer than a half-page. Return to your Financial Management Principles section on part one of this project. Look more closely at two of those principles and expand upon how those principles ensure compliance with your third party payor standards.

Reimbursement Methods

This section is no longer than a half-page. Identify two strategies you would recommend organizations implement to receive full and timely reimbursement on claims from your third party payor.

Part 4: Operational and Strategic Planning in Healthcare

Pay-For-Performance Incentives

This section is no longer than a half-page. What are two operational recommendations you would make to improve performance measures so your organization can maximize reimbursement? Please explain how these two recommendation will help to improve performance measures.

Operational Performance Measures

This section is no longer than a half-page. What are two performance measures that should be benchmarked so reimbursement is maximized? Why?

Teamwork and Strategic Planning

Use the chart below for this section. Please select two techniques.

Communicating Strategic Planning Across Teams

This section is no longer than a half-page. Identify and explain two methods you would use to communicate information to key stakeholders. For example, how would you communicate the same decision to patients, administrative staff, and clinicians?

Financial and Reimbursement Strategies

Use the chart below for this section.

References

Per APA requirements, references are written in alphabetical order. Only the first line of each reference is indented. See the course for more on how to write references in APA.

You will want to update this page with every milestone.