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Billing and Reimbursement
a. Analyze how third-party policies would be used when developing billing guidelines for patient financial services (PFS) personnel
and administration when determining the payer mix for maximum reimbursement. How do third party policies impact the payer
mix for maximum reimbursement?
b. Organize the key areas of review in order of importance for timeliness and maximization of reimbursement from third-party payers. Explain
your rationale on the order.
c. Describe a way to structure your follow-up staff in terms of effectiveness. How can you ensure that this structure will be effective?
d. Develop a plan for periodic review of procedures to ensure compliance. Include explicit steps for this plan and the feasibility of enacting this
plan within this organization.
IV. Marketing and Reimbursement
a. Explain how new managed care contracts impact reimbursement for the healthcare organization. Support your explanation with concrete
evidence or research.
b. Discuss the resources needed to ensure billing and coding compliance with regulations and ethical standards. What would happen if
these resources were not obtained? Describe the consequences of noncompliance with regulations and ethical standards.
c. Evaluate strategies to ensure stakeholders involved the reimbursement process adhere to ethical standards.