Managers need to be prepared for changes in both reimbursement policy and overall changes to the healthcare system. Since Medicare and Medicaid make up a growing portion of all healthcare reimbursement in the United States, it is important that healthcare managers monitor changes to the Centers for Medicare and Medicaid (CMS) reimbursement guidelines.
Reimbursement policy has long been an issue for healthcare managers and organizations. Healthcare reimbursement often requires a lot of supporting documentation, specialized coding and billing processes, and other administrative aspects that can become time-consuming and costly for any organization. This is why ensuring a solid understanding of reimbursement policies by the major third-party payers in the healthcare field is important. Recently, the Patient Protection and Affordable Care Act and other CMS changes to reimbursement required healthcare organizations to analyze and review their policies related to billing, coding, and collecting revenues from government payers such as Medicaid and Medicare.
In this assignment you will assume the role of a mid-level manager at a community-based hospital and have the opportunity to analyze the PPACA and CMS changes and their impact on the organization. You will also prepare an executive summary detailing the recent changes in tax reimbursement at the organization.
Upon successful completion of this assignment, you will be able to:
- Evaluate strategic planning and organizational management of healthcare delivery systems.
Resources
- Article: CMS Strategy: The Road Forward
- Article: Hospital Reimbursements and the ACA
Background Information
In this activity you assume the role of a mid-level manager at a community-based hospital. Your supervisor has expressed concerns that much of the administrative staff does not fully understand the implications of the Affordable Care Act (ACA) as well as other key changes to Medicare and Medicaid made by CMS.
You have been asked to chair a meeting of department heads in order to explain these changes and discuss strategies moving forward.
In preparation for the meeting you need to develop an executive summary that will be distributed at the meeting highlighting the changes as a result of the ACA. This summary should include an overview of CMS regulatory and reimbursement changes.
Instructions
- Review the rubric to make sure you understand the criteria for earning your grade.
- Review these articles:
- “CMS Strategy: The Road Forward” from the Centers for Medicare and Medicaid Services website.
- “Hospital Reimbursements and the ACA” from the Health Professionals and Allied Employees (HPAE) website.
- Review the scenario described in the Background Information section above.
- Considering the articles and the scenario, create an executive summary that will be distributed to your peers. Your executive summary should:
- Be 250-500 words in length
- Include any in-text citations in APA formatting
- Include APA formatting for references and formatting