Jackson Health System is one of the nonprofit academic medical system organizations, which are offering excellent care services in the world to any individual who visits it. The Public Health Trust manages this organization. The Public Health Trust is actually a group of citizens’ volunteers who are acting on behalf of the Miami-Dade Board of County Commissioners. This health organization is committed to structuring the healthcare of the public by offering a single as well as high standard of quality health care for the occupants of Miami-Dade County, which is one of the Counties in Miami State of the United States.

Under the Jackson Health System, there is an integrated system, which is applied in the health care provisions. This integrated system comprises of the following subdivisions: First is the Jackson South Medical Center, second is the Jackson Memorial Hospital, third is Jackson Behavioral Health Hospital among many more other health facilities which are under Jackson Health System. The Jackson Health System has also the many primary care as well as specialty care units. Among this are the two well-known long-term care-nursing facilities as well as the corrections health facilities. Specifically, the main aim of this business case is pursuing on the improvement of the billing and collections processes of the Jackson Health System. After the organization’s analysis, this area was specifically identified as an area where improvement was required, upon the improvement of the billing and collections processes, the performance of the organization is anticipated to improve to a greater extend (Nichols et al. 2018).

2 Introduction

2.1 Purpose of Business Case

This Business Case Analysis for Jackson Health System includes an objectively documented analysis, comparison of alternatives and recommendation to address the billing and collections challenges faced by Jackson Health System. These challenges include the failure of practices to confront as well as deal with issues raised by the customers on medical bill collection section, high deductible health plans, the economy, unemployed as well as uninsured patients without forgetting the nature of patient expectations. It is being submitted to the Jackson Health System Financial Management team for recommending some of the best billing and collection processes that can be embraced by the organization so that it gets itself out of these billing and collection predicaments (Shaaban, & Thandra, 2017). Alternatives are compared based on the best billing and collection practices that are being applied by the best-known hospitals in the United States as well as in the globe at large. Some of the hospitals where the alternatives have been recommended from include, The Mayo Clinic, Cleveland Clinic, Singapore General Hospital as well as Johns Hopkins Hospital among many more in the world class list.

3 gENERAL Project iNFORMATION

3.1 Problem Statement

The Jackson Health System usually faces a challenge in the billing and collection of medical bills when dealing with patients who are not covered with any health insurance. More especially in the Laboratory tests, medication, as well as pharmacy sections because of the greater number of patient being served and the inability of other patients to afford the medical bills. This happens in a scenario where a person from a low-income family is given a medical bill of for instance more than $400 to pay over the counter before receiving medications (Webb, 2015).

3.2 Background and Context

It is important to note that bill collection has never been a simple task. This situation is much more realistic for the medical bill collections, which Jackson Health System has itself into a dilemma. In fact, according to a consumer credit report survey, 51.2% of collection trade lines are emanating from the unpaid medical bills. This survey also indicates further that, more than 42.9 million individuals have outstanding medical bills in the entire United States (Aiello et al. 2017). From these statistics, it is true that the healthcare facilities faces serious challenges with regard to billing and collections from the customers who happen to be the patients. According to an article done by the Medical Group Management Association, together with the association for medical practice executives as well as leaders shows that, the major challenges faced by the hospitals in collecting the bills include:

a) Inability of the hospitals to confront as well as handle the issues as expected.

b) The deductible health plans are too high.

c) Most of the low-income families are not employed hence uninsured.

d) The low expectations of the patients regarding their medical bills.

It is important to note that, to overcome the challenges of billing and collections, the hospitals must first be willing to execute new policies as well as procedures when there is a necessity. Failure to implement the policies as well as the necessary will make the hospitals where Jackson Health System to face difficult financial crisis which will become much more difficult for them to get out of, besides impairing their performance as well as service delivery. The best way to terminate the challenges is to adopt the use of technology in the billing and collection process besides the legislature of the great United State moving with agency to enact laws, which will assist the healthcare facilities get out of the billing and collections predicaments. This will call for the government to ensure that all its citizens are insured under a government plan (Rivenbark, & Peterson, 2019)

If the medical billing and collection challenges are addressed, then the integrity of the doctors as well as nurses in their services delivery will be much improved besides the accountability of both hospitals and the healthcare providers. Failure to which, the value of the American health system will not be worth any more to its citizens because most of the services will be impaired due to financial crisis.

The problem being encountered in Jackson Health System is late payment of bills or completely inability of the patients to pay the bills. Why? The patients are issued with bills, which they are unable to afford, the second why? Most of the patients are not insured, why? They are not employed, Why? They lack the academic qualifications or there is no employment for them, why? Poor government policies regarding the health insurance as well as unemployment levels without forgetting poor billing collection techniques by Jackson Health System, why? Because of the inability of the government as well as the organization to implement new policies and procedures in medical bill collections. Counter-measure, the legislature and the Jackson Health System financial management team should move with urgency to formulate and execute new policies and procedures regarding billing and collections (Joshi-Patel, Walker, & Lo, 2018).

3.3 Goals

By address this billing and collections challenge at Jackson Health System, the following foals will be achieved:

a) The rate of failure in capturing the patients’ data will be minimized by almost 90% hence facilitating the reimbursements from claims.

b) The negligence of making the patients aware of their financial responsibilities regarding their medical bills will be greatly reduced by almost 95%, hence avoiding many instances of collection issues.

c) The cases of inaccurate coding will be greatly be reduced by almost 70% since this is the area which registers the highest cases of billing and collection errors. But with the embrace of technological bill collection methods, the inaccurate coding instances will be a thing of the past.

d) With the eradication of manual claims management processes, the Jackson Health System revenue collection department will be highly improved hence increasing the organization’s revenue collection by 7% in the first quarter of the financial year.

3.4 Scope

As far as the improvement of Jackson Health System is a concern, the billing and collections challenge should be undertaken with urgency in all its integrated systems. To start with, the sections of emergency, consultation, laboratory tests as well as medication should be the first sections to embrace the above proposed recommendations as far as the billing and collections processes are a concern. The financial department of Jackson Health System should ensure that all the necessary measures are put in place to capture all the information regarding the patients who visited the Jackson Health Systems facilities for ensuring that there is easy billing and collections process. This will also reduce the delay in reimbursements as a result of inability to capture the patients’ information (Lo, Walker, Dutta, & Joshi-Patel, 2018).

References:

Aiello, F., Durgin, J., Daniel, V., Messina, L., Doucet, D., Simons, J., ... & Schanzer, A. (2017). Surgeon leadership in the coding, billing, and contractual negotiations for fenestrated endovascular aortic aneurysm repair increases medical center contribution margin and physician reimbursement. Journal of vascular surgery, 66(4), 997-1006.

Joshi-Patel, A. A., Walker, L., & Lo, H. Y. (2018). Improving Critical Care Documentation and Billing Amongst Pediatric Hospital Medicine Providers.

Lo, H. Y., Walker, L., Dutta, A., & Joshi-Patel, A. (2018). Improving Billing Practices for Patients Admitted for Neonatal Fever.

Nichols, K. M., Caperell, K., Cross, K., Duncan, S., Foster, B., Liu, G., ... & Kim, I. K. (2018). Analysis of Patient Visits and Collections After Opening a Satellite Pediatric Emergency Department. Pediatric emergency care, 34(4), 243-249.

Rivenbark, T., & Peterson, J. (2019). Coding and Billing. In Deer's Treatment of Pain (pp. 821-824). Springer, Cham.

Shaaban, A. F., & Thandra, V. (2017). U.S. Patent Application No. 14/756,617.

Webb, R. (2015). Billing, Collections, and Cash Flow. In Agency (pp. 257-260). Palgrave Macmillan, New York.

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BILLING AND COLLECTIONS

Business Case

TABLE OF CONTENTS

1 Executive Summary