Competency Apply Principles Of Finance And Accounting 572600

Competencyapply Principles Of Finance And Accounting To Healthcare Out

Apply principles of finance and accounting to healthcare outcomes, reimbursements, and business operations.

After an evaluation of its current financial status and an assessment of future industry trends, the governing board for Metropolitan Memorial has approved its CEO’s request to expand operations into the rural areas of the state. Many of the rural residents rely upon Medicare and Medicaid for the financing of their healthcare needs. The hospital will offer satellite services including primary care, urgent care, telehealth, and emergent care services. The hospital is embracing the concept of value-based care given the economic make-up of the population within the rural community.

Value-based care focuses on advancing the triple aim strategy of providing better care for individuals, improving population health management initiatives, and reducing overall health costs.

Paper For Above instruction

In the evolving landscape of healthcare, financial management plays a critical role in ensuring sustainability, quality, and accessibility of services. With Metropolitan Memorial's plans to expand into rural communities, a comprehensive understanding of the revenue cycle management, value-based care models, and strategic financial planning becomes indispensable. This paper explores the principles of finance and accounting as they relate to healthcare outcomes, assesses the revenue cycle process, examines CMS value-based care initiatives, and provides strategic recommendations to strengthen financial operations amid this transition.

Revenue Cycle Management in Healthcare

The revenue cycle in healthcare encompasses all administrative and clinical functions that contribute to the capture, management, and collection of patient revenue. It begins with patient scheduling and registration, encompasses clinical services, coding, billing, and claims processing, and concludes with collections and accounts receivable management. Effective revenue cycle management (RCM) ensures timely and accurate reimbursements, minimizes denials, and optimizes cash flow—crucial factors for hospital operations, especially during expansion phases into new markets like rural areas.

Implementing advanced electronic health records (EHR) systems and revenue cycle management software improves billing accuracy and facilitates real-time claim status tracking. Additionally, staff training on coding compliance and insurance verification can significantly reduce billing errors and denials, leading to enhanced revenue integrity. As Medicaid and Medicare constitute the majority of payer sources in the rural expansion, understanding the intricacies of federal and state reimbursement policies is essential for maximizing revenue.

Value-Based Care Models and CMS Initiatives

Value-based care (VBC) models aim to shift the focus from volume to value, rewarding providers for delivering high-quality, efficient care that improves patient outcomes (Mathews & Wills, 2020). The Centers for Medicare & Medicaid Services (CMS) has pioneered several programs encouraging this paradigm shift, notably Accountable Care Organizations (ACOs) and the Medicare Shared Savings Program (MSSP).

ACOs are networks of providers collectively responsible for the quality and cost of care delivered to Medicare beneficiaries. They incentivize providers to collaborate, reduce unnecessary hospitalizations, and emphasize preventive care. The MSSP offers shared savings rewards to ACOs that meet specific quality and cost benchmarks, promoting efficiency and high standards of care (CMS, 2021).

For Metropolitan Memorial, participation in these models can facilitate financial sustainability by aligning reimbursement with quality metrics, engaging in risk-sharing agreements, and fostering integrated care pathways tailored to rural populations. These programs can also help to optimize resource utilization and improve population health outcomes.

Strategic Financial Recommendations for Transition to Value-Based Care

Transitioning to a value-based care framework necessitates strategic financial planning. A primary recommendation is to develop data analytics capabilities that monitor clinical and financial performance metrics. By leveraging health informatics, the hospital can identify care gaps, reduce unnecessary utilization, and target interventions that improve outcomes while controlling costs (Baker et al., 2018).

Secondly, establishing partnerships with community organizations can support preventive health initiatives and chronic disease management programs, which are critical in rural settings. These collaborations can lead to shared savings and expanded care options, thus strengthening financial stability.

Thirdly, investing in staff education and training focused on value-based care principles ensures that clinicians and administrative personnel are aligned with organizational goals. This alignment fosters a culture of continuous improvement and compliance with CMS requirements (Skoufalas et al., 2021).

Finally, adopting flexible payment models and exploring alternative revenue sources, such as telehealth services and grants, can diversify income streams and buffer against reimbursement variability inherent in Medicaid and Medicare.

Conclusion

By effectively managing the revenue cycle, embracing CMS value-based care models, and implementing strategic financial initiatives, Metropolitan Memorial can position itself for successful expansion into rural markets. These efforts will foster improved healthcare outcomes for local populations, enhance financial performance, and support the hospital’s mission of accessible, high-quality care for all.

References

• Baker, L., Li, J., & Marmor, G. (2018). Data analytics for healthcare organizations. Journal of Healthcare Management, 63(5), 338-347.
• Centers for Medicare & Medicaid Services (CMS). (2021). Medicare Shared Savings Program. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SharedSavingsProgram
• Mathews, K., & Wills, B. (2020). Transitioning to value-based care: Opportunities and challenges. Healthcare Management Review, 45(2), 123-132.
• Skoufalas, A., Kruse, C., & Rose, S. (2021). Staff engagement and training in value-based healthcare. Journal of Nursing Administration, 51(4), 188-194.
• Williams, M. V., & Weintraub, A. (2019). Strategies for financial sustainability in rural healthcare. Rural and Remote Health, 19(4), 1-11.