Reimbursement

Reimbursement

ABC

The ABC should have a reflection on the primary trade-off that is developed during the process conducted by the various chief stakeholders. In every practice, the negotiation process is always embedded, therefore making it difficult for the individuals who are not directly involved in understanding nor even seeing the manner in which the decisions are made (Jones et al., 2018). Despite the fact that the trade-offs happen in every budget cycle, it is likely to rise in occasions where the resources are limited. The second method is through the utilization of the decremented and incremental budgets that can be used to adjust the budget downwards or upwards from the previous seasons. With the application of incremental budget, the line items and the units are consistently increased across all the procedures and the equipment when the need arises.

On the other hand, the detrimental budgets help in reducing the units of the equipment that are being utilized in particular procedures and purchasing the equipment that can play double roles or more than two roles at a go hence reducing the cost of billing various information on one procedure or one equipment. According to Berger (2018), the application of increase and decrease uniformly helps in reducing the chances of conflicts that may arise and prevent expedites decision making in the health care facility.  Lastly, the health facility can decide to have a budgeting method at the beginning of every year that can be used in the budgeting, billing, and payment of the procedures and equipment used in the delivery of health care services. Therefore, ensuring that every staff in the organization is using the same billing and documentation strategy hence reducing confusion and complication among the staff.

WPS

To improve the process, WPS should be particular on the various services that are being offered in the health care facility. The WPS should also identify every equipment that is being used in the process of health care management to help in improving the process. In this case, being specific will help the CMS to justify the costs of the services and the equipment being used hence efficiency and effectiveness in the process.

I would recommend that the billing staffs need to be involved the more particularly when dealing with the coding of every service and equipment being used in the delivery of health care services to ensure that proper codes are used concerning what was used and need payment. Besides, the organization can hire an external company or an external expert to be checking on the documentation of the hospital every week or every month to identify fault documentation and corrections to be made immediately before the cause of the damage (Devine, O’Clock & Lyons, 2016). At times poor documentation results in poor outcomes, especially in the coding system from the units in the hospital to the billing side. Therefore, it is crucial to have an expert who can be reviewing and advising on a better billing system and strategies.

Also, the health care facility should organize for the training of the staff members on the issue pertaining to proper documentation, and frequent refresher seminars should be conducted among the staff to remind them of appropriate documentation and teach them on better strategies of documentation. The WPS should be communicating to both the billing staff and the health care staff to ensure there is proper documentation of equipment, procedures, and particular services offered within the hospital.

References

Berger, S. (2018). Fundamentals of health care financial management: A practical guide to fiscal issues and activities. John Wiley & Sons.

Devine, K., O’Clock, P., & Lyons, D. (2016). Health-care financial management in a changing environment. Journal of business research, 48(3), 183-191.

Jones, C., Finkler, S. A., Kovner, C. T., & Mose, J. (2018). Financial Management for Nurse Managers and Executives-E-Book. Elsevier Health Sciences.