Milestone

IHP 630 Milestone One Guidelines and Rubric Overview: As you complete each section of your final project, remember that you are assuming the role of hospital administrator, so you will identify the important elements of healthcare insurance plans and the overall impact of financial management principles. Financial principles to focus on include the elements of the revenue cycle, types of reporting, and the financial data that is needed for hospital administrators to evaluate the cost and quality of processes. Prompt: Submit a draft of the Financial Principles and Reimbursement portion of your research and analysis. Specifically, the following critical elements must be addressed:

II. Financial Principles and Reimbursement: a) Reimbursement Strategies: What is the impact of case rates and management utilization data on pay-for-performance incentives? Be sure to

provide support for your response. b) Reimbursement Methods: Analyze reimbursement methods, describing the advantages and disadvantages of each method in terms of strategic

planning for operational performance. For example, why might one method be more advantageous than another at a hospital or at a physician’s office?

c) Financial Management Principles: Compare and contrast financial management principles such as financial data that describe financial performance of revenue reimbursement, benchmarking of industry standards, payer-mix breakdown of payers, and case rate and utilization rate data used to evaluate operational performance.

d) Accounts Receivable: What are the challenges associated with collecting payments for the accounts receivable or collections department, and what is the significance of monitoring cash flow and days in accounts receivable in terms of reimbursement?

e) Teamwork Principles: Compare and contrast collaborative teamwork principles to most effectively develop strategic planning that involves cross- disciplinary teams. In other words, what principles work best for teams where individuals are from both clinical and non-clinical departments? What are some of the challenges this might present for cohesive collaboration? Be sure to provide support for your response.

f) Maximizing Reimbursement: Generally speaking, to what extent do you feel healthcare organizations utilize case rates and management utilization to maximize reimbursement from both government and third-party payer payment systems? Be sure to provide support for your response.

Rubric Guidelines for Submission: Your draft of the Financial Principles and Reimbursement portion of the research and analysis should be 2–3 pages in length and should be double-spaced in 12-point Times New Roman font with one-inch margins. All citations and references should be formatted according to current APA guidelines. Include at least two references.

Critical Elements Proficient (100%) Needs Improvement (70%) Not Evident (0%) Value

Financial Principles and Reimbursement:

Strategies

Logically assesses the impact of case rates and management utilization data on pay-for- performance incentives, supporting response

Assesses the impact of case rates and management utilization data on pay-for-performance incentives, supporting response, but with gaps in logic, detail, or relevant support

Does not assess the impact of case rates and management utilization data on pay-for- performance incentives

25

Financial Principles and Reimbursement:

Methods

Accurately analyzes reimbursement methods, describing the advantages and disadvantages of each method in terms of strategic planning for operational performance

Analyzes reimbursement methods, describing the advantages and disadvantages of each method, but with gaps in accuracy, detail, or relevancy to strategic planning for operational performance

Does not analyze reimbursement methods, describing the advantages and disadvantages of each method in terms of strategic planning for operational performance

10

Financial Principles and Reimbursement:

Management

Accurately compares and contrasts financial management principles used to evaluate operational performance

Compares and contrasts financial management principles used to evaluate operational performance but with gaps in accuracy, relevancy, or detail

Does not compare and contrast financial management principles used to evaluate operational performance

10

Financial Principles and Reimbursement:

Receivable

Logically assesses the challenges associated with collecting payments and explains the significance of monitoring cash flow and days in accounts receivable in terms of reimbursement

Assesses the challenges associated with collecting payments and explains the significance of monitoring cash flow and days in accounts receivable, but response has gaps in logic or detail or is irrelevant to reimbursement

Does not assess the challenges associated with collecting payments, and does not explain the significance of monitoring cash flow and days in accounts receivable

10

Financial Principles and Reimbursement:

Teamwork

Logically compares and contrasts collaborative teamwork principles for most effectively developing strategic planning that involves cross-disciplinary teams, supporting response

Compares and contrasts collaborative teamwork principles for most effectively developing strategic planning that involves cross-disciplinary teams, supporting response, but with gaps in logic, detail, or relevant support

Does not compare and contrast collaborative teamwork principles for developing strategic planning that involves cross-disciplinary teams

10

Financial Principles and Reimbursement:

Maximizing

Logically assesses the extent to which healthcare organizations utilize case rates and management utilization data to maximize reimbursement from both government and third-party payer payment systems, supporting response

Assesses the extent to which healthcare organizations utilize case rates and management utilization data to maximize reimbursement from both government and third-party payer payment systems, supporting response, but with gaps in logic, detail, or relevant support

Does not assess the extent to which healthcare organizations utilize case rates and management utilization data to maximize reimbursement from both government and third-party payer payment systems

25

Articulation of Response Submission has no major errors related to citations, grammar, spelling, syntax, or organization

Submission has major errors related to citations, grammar, spelling, syntax, or organization that negatively impact readability and articulation of main ideas

Submission has critical errors related to citations, grammar, spelling, syntax, or organization that prevent understanding of ideas

10

Total 100%