CMS Regulations And Reimbursement Models Paper

Impact of CMS Regulations and Reimbursement Models

The Health Care Industry HCM307-1802B-03

Unit 1- Individual Project 1

Michael Green

May 22, 2018

Introduction

Healing Hands Hospital is preparing financially for the many different reimbursement changes associated with Medicare Advantage Plans. My financial team and I, have been asked to evaluate our current billing and operations workflow processes and incorporate the current trends. We will be discussing how Medicare Advantage affects Healing Hands Hospital, and how we can utilize these trends to maximize patient care.

Organizational Budget

Reimbursement and financial trends will change go hand and hand. The Healing Hands Hospital needs to rely on the revenue

If the patient shall say longer they are more than likely to get even sicker or can catch an infection and their health should diminish prolonging their stay. This scenario is not good for any business. The length you stay in the hospital is very costly, in regards to the hospitals budget and income, we do want to see as many of our patients as possible. We want to be able to get out patients checked in and out in a timely fashion, so that we run less risk of additional sickness and

For example, hospitals can ensure that all written policies for assisting low-income patients are applied consistently. In addition, hospitals can review their current charge structures and ensure that they are reasonably related to both the cost of the service and to meeting all of the community’s health care needs. Finally, hospitals could also implement written policies about when and under whose authority patient debt is advanced for collection.

The Financial Impact of MACRA

In typical bundled payment models, providers and payers share in savings and/or losses. When actual health care costs fall below the lump-sum payment, both parties keep a portion of the difference as additional profit. Conversely, the provider must provide extra services at a loss when health care costs exceed the lump-sum payment, though payers mitigate some of this loss. The potential for savings for payers lies in upfront discounted payments for episodes of care, as well