You are assessing the payer-patient mix for a healthcare organization Currently, your payer mix is 40% Medicare, 10% Medicaid, 25% traditional indemnity insurance, 20% managed care and 5% self-pay patients Complete the following:
1) Describe and define what is a fee schedule is and the centers for Medicaid services, CMS set their fee schedules each year. Look up CPT code 99214-office visit and explain the fee schedule from CMS.
2) Explain how and why indemnity insurance differ from Medicare rates. Also consider managed care rates.
Diss the differences between the rates and CMS. Also try to find data statistics on the reimbursement differences between Medicare, Medicaid, managed care and traditional indemnity as well as trends over the past few years, Find information about what percentage they offer from one another and how much they go up or down annually.
Discuss how accounts receivables are affected by the differing offering rates and how it would be impacted if there were major changes in payer mix. Define accounts receivables then discuss why and how AR plays a role in healthcare organizations if the account receivables were averaging 30 to 60 days to get paid on a claim, then to 60 to 90 days , and finally 90 to 120 days. Consider concepts such as the longer it takes to get reimbursed the more cash flow issues the organization has. (days of cash on hand)
4) discuss strategies for improving collections processes and reducing the amount of time that a bill spends in Accounts Recievable
5) Discuss how a provider might be able to change their payer mix. For example, if a provider was primarily Medicaid and Medicare but would like to get more into managed care and indemnity market or even private pay market what are some of the strategies and best practices to make this transition.
The body of the resultant paper should be 10-12 pages in APA format Spread sheets demonstrating the accounts receivable analysis will be attached as the appendices and at 7 relevant peer-reviewed academic or professional references published within the past 5 years Also attach appropriate fee schedules