Essay Grade

Overview
Write a 3–4-page proposal for billing changes and explain how the proposed changes
will benefit the organization, the physicians, and the patients.
Note: The assessments in this course build upon each other, so you are strongly
encouraged to complete them in sequence.
By successfully completing this assessment, you will demonstrate your proficiency in the
following course competencies and assessment criteria:
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Competency 1: Develop financial strategies to address dynamic environmental forces.
(L24.2, L24.5, L17.2)
• Develop a step-by-step process for a revenue cycle.
• Recommend a pricing structure method.
Competency 2: Analyze the cost and revenue implications for organizational changes
due to environmental forces. (L18.2, L12.1)
• Explain the factors to consider for insurance contract negotiations.
• Explain a process for handling private pay and charity care.
• Recommend a billing software system.
• Explain how billing process changes benefit physicians, clinics, and patients.
Competency 4: Communicate in a manner that is scholarly, professional, and consistent
with expectations for professionals in health care administration. (L6.1, L6.2, L6.3, L6.4)
• Write content clearly and logically with the correct use of grammar, punctuation,
and mechanics.
• Format citations and references using the APA style.
Content
Regardless of the corporate structure, health care organizations must remain financially
viable. Income must be forecasted according to existing contracts with stakeholders,
such as insurers and private payers and state and federal payers.
Health care leaders must also deal with the reality of finite resources, including caring
for patients with limited or no resources. The Emergency Medical Treatment and Active
Labor Act (EMTALA) requires triage and emergency care for patients in need (Social
Security Administration, n.d.). Health care executives are responsible to support
emergency care, and they must manage finite resources to achieve this legal imperative.
Reference
Social Security Administration. (n.d.). Compilation of the social security laws. Retrieved from
http://www.ssa.gov/OP_Home/ssact/title18/1867.htm
Questions to Consider
To deepen your understanding, you are encouraged to consider the questions
below and discuss them with a fellow learner, a work associate, an interested
friend, or a member of your professional community.
•
•
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?
Assignment Instruction
Preparation
Use the Capella University Library and the Internet to locate resources and
information on health care revenue cycles and billing processes.
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.
There is no specific format you must follow for this assessment, but be sure that
your proposal is clear, logical, and succinct. Follow APA guidelines for any in-text
citations and references. Include a title page and reference page.
Requirements
Write a proposal for changes you would like to make to the billing policies and
procedures in a successful physician’s clinic. Include the following in your
proposal:
• Develop a step-by-step process for the entire revenue cycle from preverification 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.
Additional Requirements
•
•
•
•
•
•
Include a title page and reference page.
Number of pages: 3–4.
At least three current scholarly or professional resources.
APA format for in-text citations and references.
Times New Roman font, 12 point.
Double-spaced.
7/10/2019
Revenue and Reimbursement Scoring Guide
Revenue and Reimbursement Scoring Guide
CRITERIA
NON-PERFORMANCE
BASIC
PROFICIENT
DISTINGUISHED
Develop a step-bystep process for a
revenue cycle.
Does not develop a
step-by-step
process for a
revenue cycle.
Develops a process for
a revenue cycle but
does not include each
step, or puts steps in
an illogical or
inaccurate sequence.
Develops a stepby-step process
for a revenue
cycle.
Develops a step-by-step
process for a revenue cycle
and explains the function or
importance of each step.
Recommend a
pricing structure
method.
Does not
recommend a
pricing structure
method.
Identifies one or more
pricing structures but
does not recommend
one
Recommends a
pricing structure
method.
Recommends a pricing
structure method, and
explains how the pricing
structure method supports
the financial strategies of
the organization.
Explain the factors
to consider for
insurance contract
negotiations.
Does not explain
the factors to
consider for
insurance contract
negotiations.
Identifies the factors to
consider for insurance
contract negotiations.
Explains the
factors to
consider for
insurance
contract
negotiations.
Explains the factors to
consider for insurance
contract negotiations, and
identifies the major payer
categories appropriate for
the practice.
Explain a process
for handling private
pay and charity
care.
Does not explain a
process for
handling private
pay and charity
care.
Identifies a process for
handling private pay
and charity care.
Explains a
process for
handling private
pay and charity
care.
Explains a process for
handling private pay and
charity care, and how the
process fits into the financial
strategies of the
organization.
Recommend a
billing software
system.
Does not
recommend a
billing software
system.
Describes billing
software systems but
does not recommend
one.
Recommends a
billing software
system.
Recommends a billing
software system by
comparing the benefits and
limitations of each in terms
of organizational needs and
financial strategies.
Explain how billing
process changes
benefit physicians,
clinics, and patients.
Does not explain
how billing process
changes benefit
physicians, clinics,
and patients.
Lists the benefits of
billing process
changes.
Explains how
billing process
changes benefit
physicians,
clinics, and
patients.
Explains how billing process
changes benefit physicians,
clinics, and patients.
Provides supporting
references and examples.
Write content clearly
and logically with
the correct use of
grammar,
punctuation, and
mechanics.
Does not write
content clearly,
logically, or with the
correct use of
grammar,
punctuation, and
mechanics.
Writes with errors in
clarity, logic, grammar,
punctuation, or
mechanics.
Writes content
clearly and
logically with the
correct use of
grammar,
punctuation, and
mechanics.
Writes clearly and logically
with the correct use of
spelling, grammar,
punctuation, and
mechanics; uses relevant
evidence to support a
central idea.
Uses APA to format
citations and
references but with
numerous errors.
Formats citations
and references
using the APA
style with few
errors.
Formats citations and
references with no errors.
Format citations and Does not format
references using the citations and
APA style.
references using
the APA style.
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