Prompt: Submit a draft of the Third-Party Payment Systems and the Operational and Strategic Planning in Healthcare portions of your research and analysis.
Guidelines for Submission: Your draft of the third-party payment systems and the operational and strategic planning in healthcare portions of your research and analysis should be 2–3 pages in length and should be double-spaced in 12-point Times New Roman font with one-inch margins, in a single Microsoft Word document. All citations and references should be formatted according to current APA guidelines. Include at least two references.
Please be careful here! For the purposes of this paper, government payers like Medicare, Medicaid, and Tricare are not considered third party payers.
First and foremost, you are only focusing on third party commercial payers. You’ve already hit CMS. This time I want you to focus on insurance that would be provided by employers. Companies like Blue Cross, Aetna, and Kaiser Permanante are among the big ones and are all fair game. You may find it helpful to visit their sites.
Let’s talk organization for Milestone Three. As you have done for Milestone One and Two, please use subheadings for each category in the rubric.
This milestone is longer and includes two main sections, Third Party Payment Systems and Operational and Strategic Planning in Healthcare.
After your title page, center Third Party Payment Systems at the top of page two. You will notice that this section of the paper is organized in the same manner, and answers the same questions, as Milestone Two. The difference is that this time you are focused solely on third party commercial payers. The financial principles are those that you identified in previous milestones — benchmarking, payer mix, revenue reimbursement, and case rate and management utilization data.
For the final section of the paper, start a new page and center Operational and Strategic Planning in Healthcare at the top. Your headings under this final section include the following:
- Pay for Performance Incentives (Please note that this section takes you back to Milestone One and your discussion in the first part of Milestone One. Here’s where the analysis comes in.)
- Operational Performance Measures (I’m looking for two here. You may find that you are using the ones you detailed in your Week Six journal. The key is that you must tie the performance measures to financial performance.)
- Financial and Reimbursement Strategies
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