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Healthcare revenue-cycle management is a strictly managed and closely monitored process that impacts the patient

Overview

Healthcare revenue-cycle management is a strictly managed and closely monitored process that impacts the patients (beneficiaries), providers, or payers. Therefore, it is important for both stakeholders to understand the other’s perspective, so that they have a more holistic view of the entire process. The following flowcharts capture the revenue cycle from the patient’s perspective and the facility’s perspective.

Text-only versions of the images below are available: Module One Activity Revenue Cycle Images Text-Only Version.

Casto, A. (2021). Principles of Healthcare Reimbursement (7th Ed). American Health Information Management Association (AHIMA). https://bookshelf.vitalsource.com/books/9781584268017

Reproduced with permission from AHIMA.This activity will help you describe the revenue-cycle process and healthcare reimbursement, as well as differentiate the components of revenue-cycle processes from various perspectives.

The activity will help you prepare for section 4 (Revenue Cycle Process) in the course project that you will be submitting in Module Nine.

Directions

Complete the provided template by analyzing the revenue cycle from both the patient perspective and the provider perspective. Then, analyze the revenue-cycle components from a third-party payer perspective.

If you need writing support, access the Online Writing Center through the Academic Support module of your course.

Specifically, you must address the following rubric criteria:

  1. Comparative Table: Create a table to compare and contrast the revenue cycle from the patient’s perspective and the provider’s perspective. Refer to Figure 1.7A and Figure 1.7B in the Overview section of this rubric to create the table.
  2. Comparison of Perspectives: Explain how the patient perspective is like the facility or provider perspective in ensuring revenue integrity. Consider the following questions to guide your response:
  3. Contrast Between Perspectives: Explain how the patient perspective differs from the facility or provider perspective in ensuring revenue integrity. Consider the following questions to guide your response:
  4. Significance for Third-Party Payer: Interpret the revenue cycle from the perspective of a third-party payer. Deduce your interpretation based on the information in the comparative table. Consider the following questions to guide your response:

Your analysis should be evidence-based. Your citations should be from your independent search for evidence (not from the textbook or module resources) of credible sources and be current within the last five years. You are required to cite a minimum of two sources, at least one of which should be separate from your own research. Refer to the IHP 630 Library Guide located in the Start Here section of the course for additional support.

What to Submit:    attachments below 

Submit the provided template as a 2- to 3-page Microsoft Word document. Sources should be cited according to APA style.

Please follow the instructions carefully as this professor is so particular.

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 Managed antivirus software (not open source) licenses for 500 workstations

In a 3-4 page paper not including the title and reference page using the Web and research the costs associated with the following items when implemented by a firm with 1,000 employees and 100 servers (since you would research only one resource for each of these in real life, you will need to obtain three (3) costs for each item):

●      Managed antivirus software (not open source) licenses for 500 workstations

●      Cisco firewall (other than residential models from LinkSys)

●      Tripwire host-based IDS for 10 servers

●      Java programming continuing education training program for 10 employees

●      Checkpoint firewall solutions

Once the costs have been identified, compare and contrast the costs for each item. Justify your choice for each item (cost, service, vendor experience, etc.). Additionally, identify if any of these require contingency plans due to known and unknown risks, and factor that cost in as well.

Clearly state what the article is about and its purpose

How the article and/or author(s) support your argument(s)

Most important aspects of the article

Any findings and conclusions

Approximately 350 to 450 words in length

Include the article “Abstract” and in your posting (your summary should be original)

Include the industry example demonstrating the application of your researched article

“IMPORTANT” – Include the reference for the article in correct APA format (5-6 REFENCES)

and citations 

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Future of Managed Health Care Delivery Systems

You will select a topic for your Final Paper related to the Future of Managed Health Care Delivery Systems, which will be submitted to your instructor for approval during Week Two.  The 10-15 page paper (excluding title and reference pages) must follow APA guidelines for written assignments and contain eight to ten scholarly and/ or peer-reviewed sources, excluding the course textbook.  

Your paper must address the following bolded topics, which should be titled appropriately in your paper:

  1. Include an Abstract which is a synopsis of the overall paper.  
  2. Managed Health Care Quality should address such factors as whether or not patient health care needs and even preferences are being met; the care is right for the illness, care is timely, and unnecessary test and procedures are not ordered.
  3. Provider Contracting is when doctors and health care practitioners have a contract agreement through a third party payer to accept a specified payment for services provided to patients.
  4. Cost Containment deals with managing the costs of doing business within a specified budget while restraining expenditures to meet a specified financial target.
  5. Effects on Medicare and Medicaid in managed health care appear to be moving in a direction where both types of recipients will be enrolled in some type of managed health care plan in the near future.  
  6. The Future Role of Government Regulations, to include ERISA and HIPAA health care policies.
  7. Include Three Recommendations each, related to quality and change in Medicare and Medicaid managed health care plans.


Writing the Final Paper

  1. Must be ten- to fifteen double-spaced pages in length and formatted according to APA style as outlined in the Ashford Writing Center.
  2. Must have a cover page that includes: 
    1. Title of paper
    2. Student’s name
    3. Course name and number
    4. Instructor’s name
    5. Date submitted
  3. Must include an introductory paragraph with a succinct thesis statement.
  4. Must address the topic of the paper with critical thought.
  5. Must end with a conclusion that reaffirms your thesis.
  6. Must use at least eight scholarly and /or peer-reviewed sources, published within the last five years, including a minimum of three from the Ashford University Online Library.
  7. Must document all sources in APA style, as outlined in the Ashford Writing Center.
  8. Must include a separate reference page, formatted according to APA style as outlined in the Ashford Writing Center.

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Abstract

            This thesis present the achievement of the managed health care delivery systems, lessons for policy makers from different parts of the world and the reforms needed to improve the quality of service delivery, reduce the cost of health care provision, increase efficiency of Medicare and Medicaid as well as the future role of government in enactment of policies and regulations. Due to dynamics in health care industry related to backlash by providers and consumers, the future of the managed health care delivery systems is uncertain in United States of America. However, proper policies and regulations in place have proved to contain the increasing health care spending without affecting the quality of service delivery.

            Some innovative technologies applied in other parts of the world that does not necessarily relied on the US market environment have shown to be more appropriate when applied in private and public health care system. For instance, placement of incentives between health care providers and acquirers, use of performance measurement report cards and continuous acquisition of equipment that integrate disease management programs address the key challenges affecting the future of the managed health care delivery systems in most parts of the world. This paper recommends for selective adoption of voluntary US insurance market and single payer systems which allows for precise monitoring of their effects and systematic lower transaction costs. In addition, pharmaceutical and………………………………………………………………………………………………………………………………………………………………………………………………………………………………….

………………………………………………………………………………………………………………………………………………………………………………………………………………………………….

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Project procurement planning details how the procurement process will be managed effectively to achieve the project’s objectives.

13. Procurement MRAnsAnedanagement

Answer question 150-200 word response

 Project procurement planning details how the procurement process will be managed effectively to achieve the project’s objectives. As such, the procurement planning has to be tailored specifically to meet the needs of various projects. Clinker Consultancy has a large internal project to be initiated. To staff this project, Clinker Consultancy is working with People Consultancy to provide three resources for six months. The resources will be part of the team managed by Clinker Consultancy for six months. How would you justify the contract type to be used by Clinker Consultancy for the project? 

Reference article paper  https://eprints.qut.edu.au/39853/1/c39853.pdf  

Reference text book notes below 

Procurement management follows a logical order. First, you plan what you need to contract; then you plan how you’ll do it. Next, you send out your contract requirements to sellers. They bid for the chance to work with you. You pick the best one, and then you sign the contract with them. Once the work begins, you monitor it to make sure that the contract is being followed. When the work is done, you close out the contract and fill out all the paperwork.

You need to start with a plan for the whole project. Before doing anything else, you need to think about all of the work that you will contract out for your project. You will want to plan for any purchases and acquisitions. Here’s where you take a close look at your needs to be sure that contracting is necessary. You figure out what kinds of contracts make sense for your project, and you try to define all of the parts of the project that will be contracted out.

Contract planning is where you plan out each individual contract for the project work. You work out how you’ll manage the contract, what metrics it will need to meet to be considered successful, how you’ll pick a seller, and how you’ll administer the contract once the work is happening.

The procurement management plan details how the procurement process will be managed. It includes the following information:

  • The types of contracts you plan to use and any metrics that will be used to measure the contractors’ performance
  • The planned delivery dates for the work or products you are contracting
  • The company’s standard documents you will use
  • The number of vendors or contractors involved and how they will be managed
  • How purchasing may impact the constraints and assumptions of the project plan
  • The coordination of purchasing lead times with the development of the project schedule
  • The identification of prequalified sellers (if known)

The procurement management plan, like all other management plans, becomes a subsidiary of the project management plan. Some tools and techniques you may use during the procurement planning stage include make-or-buy analysis and definition of the contract type

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