d5 – Revenue Cycle Management and Reimbursement Models

Competency

Apply principles of finance and accounting to healthcare outcomes, reimbursements, and business operations.

Scenario

After an evaluation of its current financial status and an assessment of future industry trends, the governing board for Metropolitan Memorial has approved its CEO’s request to expand operations into the rural areas of the state. Many of the rural residents rely upon Medicare and Medicaid for the financing of their healthcare needs. The hospital will offer satellite services including primary care, urgent care, telehealth, and emergent care services. The hospital is embracing the concept of value-based care given the economic make-up of the population within the rural community. Value-based care focuses on advancing the triple aim strategy of providing better care for individuals, improving population health management initiatives, and reducing overall health costs.

Instructions

The CEO has asked you to create a PowerPoint presentation (using speaker notes for each slide or voiceover narration) outlining the revenue cycle management process. Your presentation should include a discussion on value-based care models as introduced by the Centers for Medicare and Medicaid Services (CMS), such as ACOs and the Medicare Shared Savings Program. In addition, based on the research you’ve done, you will need to include a recommendation for a possible strategy to strengthen the organization’s financial operations in preparation for the transition to value-based care.