Compliance Monitoring Case Study
Compliance Standards and Financial Principles Healthcare organizations utilize financial principles to ensure compliance with government standards. In this case, the Centers of Medicare and Medicaid (CMS) require both monitoring and auditing for healthcare facilities. In fact, CMS requires these two principles for most managed care plans in order to protect against fraud, waste and abuse (CMS, n.d.). Monitoring and auditing are designed to detect against criminal and other improper conduct that can happen within any given facility. Therefore, monitoring takes place on an every day basis with most electronic health records (EHRs). For examples, facilities should look into buying an EHR system that has an internal monitoring program in order
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First and foremost, there is insurance registration of all patients, which is considered to be the start of the revenue cycle. For instance, healthcare administrators should make the front-desk employees a checklist to make sure they are collecting the proper insurance information when scheduling appointments. This strategy is important because it allows the patient to understand if their physician is in network, if they have a co-payment or if they need an insurance referral, which are all important reimbursements methods for the facility (Crocker, 2016). The next strategy relates to properly billing patient claims in order to receive full reimbursement. Therefore, the coders have to be educated continuously to make sure all claims are sent out to the proper payer with the correct diagnoses, services and procedures. Improper claims result in a late payment or no payment at all, which will hurt the facility’s level of reimbursement. The last strategy is to implement a financial policy for patients. A binding policy requires patient signatures as well as providing them guidance to the policy of collecting co-payments and unpaid balances. In other words, a well-written policy will prevent patients from being surprised about their financial commitment when they see the provider (Ciletti, 2004). This policy will allow the organization to collect more payments as well as helping the providers and medical staff to be properly
First and foremost, there is insurance registration of all patients, which is considered to be the start of the revenue cycle. For instance, healthcare administrators should make the front-desk employees a checklist to make sure they are collecting the proper insurance information when scheduling appointments. This strategy is important because it allows the patient to understand if their physician is in network, if they have a co-payment or if they need an insurance referral, which are all important reimbursements methods for the facility (Crocker, 2016). The next strategy relates to properly billing patient claims in order to receive full reimbursement. Therefore, the coders have to be educated continuously to make sure all claims are sent out to the proper payer with the correct diagnoses, services and procedures. Improper claims result in a late payment or no payment at all, which will hurt the facility’s level of reimbursement. The last strategy is to implement a financial policy for patients. A binding policy requires patient signatures as well as providing them guidance to the policy of collecting co-payments and unpaid balances. In other words, a well-written policy will prevent patients from being surprised about their financial commitment when they see the provider (Ciletti, 2004). This policy will allow the organization to collect more payments as well as helping the providers and medical staff to be properly