Final project submission

Running Head: OPERATIONAL & STRATEGIC PLANNING IN HEALTHCARE ORGANIZATIONS
OPERATIONAL & STRATEGIC PLANNING

Operational and Strategic Planning in Healthcare Organizations

Maria Williams
Southern New Hampshire University
04/11/2021

Operational and Strategic Planning in Healthcare Organizations

Third Party Payment Systems

Healthcare System Reimbursement

The most prominent third party payer models include the fee-for-service, fee-for-service with review of utilization, health maintenance organizations (HMO), Independent Practice Association (IPA), managed care, par-for-performance. The fee-for-service involves payment according to the total value of the services and supplies provided, and fees. This model and other value-based reimbursement models are increasing the quality of healthcare services and products since payments are made for only what has been done (Boland et al., 2017). Therefore, there are no extra unreasonable costs for services not rendered (Boland et al., 2017). Additionally, the system increases the integrity of service delivery in healthcare since all delivered services must be documented, which increases the efficiency in record-keeping, and service delivery.

Reporting Requirements

The reporting requirements include inclusion of all covered services prior to submission to third parties. Healthcare providers are required to have an accurate record of all the billed services all accurately documented with concise timelines when the services were delivered (Boland et al., 2017). Completeness, legibility, and accuracy of all billing information is crucial for successful reimbursement. These reporting requirements offer the opportunity for improvement of data storage and management systems, record keeping, file-sharing, and the quality and comprehensiveness of the products and services provided by healthcare organizations (Boland et al., 2017). However, challenges such as exclusion of undocumented but delivered services may lead to no remuneration by third parties. Therefore, it is crucial for healthcare leaders to use electronic record systems to enter and store all relevant information.

Compliance Standards and Financial Principles

Healthcare organizations utilize financial principles and compliance standards by constantly training employees to ensure that they are sufficiently competent in billing matters. This enables employees to enter and keep all billing-related information for compliance with third party requirements. Healthcare facilities also keep track of revenue cycles, and hire the right number of employees to ensure compliance with billing requirements, and increase the efficiency of the employees (Burns &Pauly, 2018).Additionally, healthcare organizations allocate enough funds for periodic purchase of efficient equipment, and maintenance of the existing resources. In doing so, healthcare organizations deliver high quality healthcare products and services whose costs fall within the limits specified in the contract with third parties, which also increases the quality of patient care.

Reimbursement Methods

In order to receive full reimbursement, and improve timeliness of reimbursement, healthcare organizations should apply the monthly charge description master (CDM). The CDM system helps in ensuring that all products and services offered are coded correctly and the billing codes are ordered accurately (Castro &Forrestall, 2015). This strategy helps in the identification of errors, which will not only ensure accuracy but also helps identify the most frequently made errors. This helps in identifying employees’ weaknesses in regard to the overall reimbursement-system competencies, which in turn makes it easy to customize employee training programs based on identified individual needs. Additionally, through front office departments, healthcare organizations should have accurate and updated insurance information for all visiting clients at the time of visitation to identify and correct any information that would delay the reimbursement timelines.

Operational and Strategic Planning in Healthcare

Pay for Performance Incentives

Operational strategies to improve performance measures for maximizing reimbursement include making entries of all patients at the time of admission, and rectifying any inconsistencies in patient records. This will help to avoid omissions and other errors that would reduce the accuracy of billing records (Vokes et al., 2018). Additionally, healthcare organizations should continuously update patient information, and review all information in the electronic health record (EHR). Reviewing and updating patient information will guide hospitals in adjusting patient information to comply with billing requirements.

Operational Performance Measures

The performance measures that should be monitored to increase reimbursement include patient satisfaction with the quality of care, stakeholder contribution, operational efficiency, and efficiency of the patient record systems. The performance prism model can be applied to monitor the standards of the main reimbursement-compliance indicators to identify weaknesses that should be rectified to increase reimbursement (Dimitropoulos, 2017). Frequently checking the record system will ensure that patient information is accurate and up-to-date, which will prevent transfer of errors to the billing system. Monitoring patient satisfaction will enable hospitals to understand the quality of their services, which will guide them in providing the right products and services in the manner stipulated in the reimbursement standards.

Teamwork and Strategic Planning

Collaborative teamwork principles that would increase reimbursement include an open and fast communication system. Fast communication increases the rate of information exchange, and coordination in teams, which in turn reduces omission of important information in patient billing records, and increases the accuracy of the billing information (Dimitropoulos, 2017). Healthcare teams should also be task-oriented to ensure that all required services are provided without failure or confusion of diagnostic, laboratory, or prescription information to ensure that all the required services were actually provided.

Communicating Strategic Planning Across Teams

Communication across the administrative teams can be done through board meetings in convenient departments. Health workers can be communicated to through workshops and seminars organized in an internal venue since these methods involve interactive properties that allow detailed elaboration and asking of questions (Burns &Pauly, 2018). Teams can also communicate through emails and direct phone calls since the methods are fast. Posters and memos can also be produced and given to support staff and pinned in notice boards. External stakeholders can be communicated via emails, external conferences and workshops, and brochures.

Financial and Reimbursement Strategies

Financial strategies that can work well include the delegation of responsibilities to finance officers. They include the comptroller who will be in charge of reporting and accounting activities, preparation of statements, and patient management. The treasurer is put in charge of capital acquisition, investment management, and risk management (Dimitropoulos, 2017). Delegation of responsibility will reduce confusion, and increase the efficiency of financial processes. Finally, a team will be formed to analyze the reimbursement compliance standards, and adjust the records to ensure accuracy and accountability.

References

Burns, L. R., &Pauly, M. V. (2018). Transformation of the healthcare industry: curb your enthusiasm?. The Milbank Quarterly, 96(1), 57-109.
Boland, G. W., Glenn, L., Goldberg-Stein, S., Jha, S., Mangano, M., Patel, S., …& Heller III, R. E. (2017).Report of the ACR’s Economics Committee on value-based payment models. Journal of the American College of Radiology, 14(1), 6-14.
Dimitropoulos, P. E. (2017). Performance management in healthcare organizations: concept and practicum. In GeNeDis 2016 (pp. 11-19).Springer, Cham.
Vokes, R. A., Bearman, G., &Bazzoli, G. J. (2018). Hospital-acquired infections under pay-for- performance systems: an administrative perspective on management and change. Current infectious disease reports, 20(9), 1-7.