This is a paper that is focusing on the payer-patient mix for a health care organization. The paper also provides guidelines on how to write the assignment paper in detail.
The payer-patient mix for a health care organization
Research Paper
Search course materials, including your text and the Internet, to find a spreadsheet program that will assist you in completing this assignment. The spreadsheet and calculations are to be attached at the end of the paper as an appendix after the Reference page.
Case Study: You are assessing the payer–patient mix for a health care organization. Currently, your payer mix is 40% Medicare, 10% Medicaid, 25% traditional indemnity insurance, 20% manage care, and 5% self-pay patients. Complete the following:
Using the most common office visit, CPT code 99214, determine the reimbursement from the Centers for Medicare and Medicaid Services (online fee schedule available for Medicare).
Using the same CPT code, 99214, determine the reimbursement for Medicaid (fee schedules should be available from the individual state).
Also, using the same CPT code, 99214, create at least 3 other traditional indemnity insurance reimbursements. If possible, use the actual reimbursement from the insurance carrier. It may be possible to obtain actual reimbursement information from your personal insurance carrier. If the information is not available, assume reimbursement by traditional indemnity insurance is usually 200% reimburse more than Medicare and Medicaid, and manage care is usually 133% more than Medicare and Medicaid.
The payer-patient mix for a health care organization
Firstly, compose an accounts receivable benchmark from this information showing columns for current, 30–60, 61–90, 90–120, and greater than 120 days.
Secondly, assess the information for areas of improved reimbursement of at least 20% or more.
Thirdly, evaluate the options available to change the payer–patient mix with consideration of related legal and ethical issues.
Fourthly, propose a best strategy with justification and rationale based on effective decision-making tenets.
The body of the resultant paper should be 10–12 pages. Spreadsheets demonstrating the accounts receivable analysis will be attached as appendices. Also, there will be at least 7 relevant peer-review academic or professional references within the past 5 years. Also attach appropriate fee schedules.
For a resource guide on using the online library to search for references
