HCM345 SNHU Billing and Reimbursement and Marketing and Reimbursement Prompt: Submit your draft of Sections III and IV of the final project. Specifically,

HCM345 SNHU Billing and Reimbursement and Marketing and Reimbursement Prompt: Submit your draft of Sections III and IV of the final project. Specifically, the following critical elements must be addressed:
III. Billing and Reimbursement
A. Analyze the collection of data by patient access personnel and its importance to the billing and collection process. Be sure to address the
importance of exceptional customer service.
B. Analyze how third-party policies would be used when developing billing guidelines for patient financial services (PFS) personnel and
administration when determining the payer mix for maximum reimbursement.
C. Organize the key areas of review in order of importance for timeliness and maximization of reimbursement from third-party payers. Explain your
rationale on the order.
D. Describe a way to structure your follow-up staff in terms of effectiveness. How can you ensure that this structure will be effective?
E. Develop a plan for periodic review of procedures to ensure compliance. Include explicit steps for this plan and the feasibility of enacting this plan
within this organization.
IV. Marketing and Reimbursement
A. Analyze the strategies used to negotiate new managed care contracts. Support your analysis with research.
B. Communicate the important role that each individual within this healthcare organization plays with regard to managed care contracts. Be sure to
include the different individuals within the healthcare organization.
C. Explain how new managed care contracts impact reimbursement for the healthcare organization. Support your explanation with concrete
evidence or research.
D. Discuss the resources needed to ensure billing and coding compliance with regulations and ethical standards. What would happen if these
resources were not obtained? Describe the consequences of noncompliance with regulations and ethical standards.
Guidelines for Submission: Your draft must be submitted as a three- to five-page Microsoft Word document with double spacing, 12-point Times New Roman
font, one-inch margins, and at least three sources, which should be cited in APA format. HCM 345 Milestone Three Guidelines and Rubric
Overview: Much of what happens in healthcare is about understanding the expectations of the many departments and personnel within the organization.
Reimbursement drives the financial operations of healthcare organizations; each department affects the reimbursement process regarding timelines and the
amount of money put into and taken out of the system. However, if departments do not follow the guidelines put into place or do not capture the necessary
information, it can be detrimental to the reimbursement system.
An important role for patient financial services (PFS) personnel is to monitor the reimbursement process, analyze the reimbursement process, and suggest
changes to help maximize the reimbursement. One way to make this process more efficient is by ensuring that the various departments and personnel are
exposed to the necessary knowledge.
Milestone Three provides you an opportunity to engage with real-world data and tools that you would encounter in an actual professional environment.
Specifically, you will begin thinking about reimbursement in terms of billing and marketing. Reimbursement is a complex process with several stakeholders; this
milestone allows you to begin thinking about the key players, including third-party billing, data collection, staff management, and ensuring compliance.
Marketing and communication also plays a vital role in reimbursement; this milestone offers a chance to begin analyzing effective strategies and their impact.
Prompt: Submit your draft of Sections III and IV of the final project. Specifically, the following critical elements must be addressed:
III. Billing and Reimbursement
A. Analyze the collection of data by patient access personnel and its importance to the billing and collection process. Be sure to address the
importance of exceptional customer service.
B. Analyze how third-party policies would be used when developing billing guidelines for patient financial services (PFS) personnel and
administration when determining the payer mix for maximum reimbursement.
C. Organize the key areas of review in order of importance for timeliness and maximization of reimbursement from third-party payers. Explain your
rationale on the order.
D. Describe a way to structure your follow-up staff in terms of effectiveness. How can you ensure that this structure will be effective?
E. Develop a plan for periodic review of procedures to ensure compliance. Include explicit steps for this plan and the feasibility of enacting this plan
within this organization.
IV. Marketing and Reimbursement
A. Analyze the strategies used to negotiate new managed care contracts. Support your analysis with research.
B. Communicate the important role that each individual within this healthcare organization plays with regard to managed care contracts. Be sure to
include the different individuals within the healthcare organization.
C. Explain how new managed care contracts impact reimbursement for the healthcare organization. Support your explanation with concrete
evidence or research.
D. Discuss the resources needed to ensure billing and coding compliance with regulations and ethical standards. What would happen if these
resources were not obtained? Describe the consequences of noncompliance with regulations and ethical standards.
Guidelines for Submission: Your draft must be submitted as a three- to five-page Microsoft Word document with double spacing, 12-point Times New Roman
font, one-inch margins, and at least three sources, which should be cited in APA format.
Critical Elements
Billing and
Reimbursement:
Data
Proficient (100%)
Analyzes the collection of data by patient
access personnel and its importance to the
billing and collection process, including the
importance of exceptional customer service
Billing and
Reimbursement:
Third-Party
Policies
Analyzes how third-party policies would be
used when developing billing guidelines for
PFS personnel and administration when
determining the payer mix for maximum
reimbursement
Billing and
Reimbursement:
Key Areas of
Review
Organizes and explains the key areas of
review in order of importance for timeliness
and maximization of reimbursement from
third-party payers
Billing and
Reimbursement:
Structure
Billing and
Reimbursement:
Plan
Describes a way to structure follow-up staff in
terms of effectiveness and explains rationale
for effectiveness
Develops a plan for periodic review of
procedures to ensure compliance, including
explicit steps and the feasibility of enacting
the plan
Analyzes the strategies used to negotiate new
managed care contracts, supporting analysis
with research
Communicates the important role that each
individual within this healthcare organization
plays with regard to managed care contracts,
including the different types of individuals
within the organization
Marketing and
Reimbursement:
Strategies
Marketing and
Reimbursement:
Communicate
Needs Improvement (75%)
Analyzes the collection of data by patient
access personnel and its importance to the
billing and collection process but does not
include the importance of exceptional
customer service
Analyzes how third-party policies would be
used but does not apply analysis toward the
development of billing guidelines for PFS
personnel and administration or toward the
determination of the payer mix for maximum
reimbursement
Organizes and explains the key areas of
review in order of importance for timeliness
and maximization of reimbursement from
third-party payers, but explanation is cursory
or illogical
Describes a way to structure follow-up staff in
terms of effectiveness but does not explain
rationale for effectiveness
Develops a plan for periodic review of
procedures to ensure compliance but does
not include explicit steps or does not include
the feasibility of enacting the plan
Analyzes the strategies used to negotiate new
managed care contracts but does not support
analysis with research
Communicates the important role that each
individual within this healthcare organization
plays with regard to managed care contracts
but does not include the different types of
individuals within the organization
Not Evident (0%)
Does not analyze the collection of data by
patient access personnel
Value
10
Does not analyze how third-party policies
would be used
10
Does not organize and explain the key areas
of review in order of importance for
timeliness and maximization of
reimbursement from third-party payers
10
Does not describe a way to structure followup staff in terms of effectiveness
10
Does not develop a plan for periodic review
of procedures to ensure compliance
10
Does not analyze the strategies used to
negotiate new managed care contracts
10
Does not communicate the important role
that each individual within this healthcare
organization plays with regard to managed
care contracts
10
Marketing and
Reimbursement:
Contracts
Marketing and
Reimbursement:
Compliance
Articulation of
Response
Explains how new managed care contracts
impact reimbursement for the healthcare
organization, including support for
explanation with concrete evidence or
research
Comprehensively discusses the resources
needed to ensure billing and coding
compliance with regulations and ethical
standards
Submission has no major errors related to
citations, grammar, spelling, syntax, or
organization
Explains how new managed care contracts
impact reimbursement for the healthcare
organization but does not include support for
explanation with concrete evidence or
research
Discusses the resources needed to ensure
billing and coding compliance with
regulations and ethical standards, but
discussion is not comprehensive
Submission has major errors related to
citations, grammar, spelling, syntax, or
organization that negatively impact
readability and articulation of main ideas
Does not explain how new managed care
contracts impact reimbursement for the
healthcare organization
10
Does not discuss the resources needed to
ensure billing and coding compliance
10
Submission has critical errors related to
citations, grammar, spelling, syntax, or
organization that prevent understanding of
ideas
Earned Total
10
100%

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