Maximizing Reimbursement: Drintin Hospital's Financial Improvement Steps - Essay Sample

Introduction

Drintin Hospital has the role of ensuring that financial revenue is utilized inappropriately, and the value delivered to the patient is paid appropriately both in terms of accuracy and timeliness (Heaton, 2019). For this to happen, the hospital must ensure that first, they understand how various components of claims managements affect reimbursement, and the success will depend on how the hospital make financial improvements simultaneously. One of the significant steps of ensuring there is an improvement in financial health is the use of reimbursement data.

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Health care fraud in Drintin Hospital is one of the reimbursements data that the hospital needs to monitor to ensure that it is minimized to the lowest point. Healthcare fraud can come as a result of any act, expression, omission, or concealment calculated by financial management in hospitals to deceive patients their bill in their disadvantage. Health care fraud typically takes the forms of false statements, cover-up strategies, and misrepresentation of value. The fraud can vary from straightforward claims to intricate financial arrangements. Health care fraud could have come from providers, insured patients, employees who pay claims to themselves, or nonrelated healthcare players who create fraud schemes.

Drintin hospital can obtain fraud reimbursement data through fraud examination where financial auditing and investigating all healthcare providers is done. The most common fraud examination is forensic analyses that reconstruct a past event using health data transactions made by all players in the hospital. Data mapping is another source of reimbursement data source, where it involves the identification of all possible data elements of study. Since Drintin hospital is a large facility dealing with a vast amount of cash, it is necessary to ensure that the management can tackle a large amount of data. Data mapping is done through the creation of audit and six-layer health care continuum components model. D The first stage of data mapping is developing a detention model, which is a discovery of clues within the data and finding the anomaly. The next step is the creation of an investigation model that tries to ascertain whether various activities or statements are authentic.

There are certain limitations that Drintin hospital needs to consider while gathering their information. One of the limitations is to ensure that their source is guaranteed since claims data on follow up duration is usually restricted to the type of hospital due to the data privacy legislation when accessing it through public means. A validated data collection instrument is another limitation the hospital should consider when sourcing reimbursement data since it needs to be first developed.

The reimbursement data that is derived from fraud analyses can be used by the hospital to implements future prevention mechanisms and initial detention of any fraud scheme. The data will help Drintin hospital to minimize the amount of money that is lost during the Reimbursement of its patients. The saved fund can be rolled into future years for Reimbursement. The use of reimbursement data will also result in patient satisfaction, which will have a positive impact on the hospital. Patient satisfaction will enable Drintin hospital to have a competitive advantage among its competitors.

How the Use of Reimbursement Data Will Assist the Hospital in Providing Quality Care

Recent reforms in health care services such as the implementation of patient protection and affordable act and the health care information technology have been creating strong external incentives to improve quality care service in hospital and Drintin is one of the health facility that has benefited from this changes. The use of reimbursement data has utilized a variety of payment mechanisms with varying degrees of effectiveness (John, 2018). Its effects have the potential to not only enhance the accuracy and efficiency of reimbursement mechanisms but have significantly resulted in improving health care quality. Drintin hospital has the opportunity of taking advantage of these measures to continue improving quality care delivery. There are many frameworks, systems, and tools to guide quality improvement efforts using reimbursement data.

Efforts to improve quality health care need to ensure that it contributes to the intended results and the desired direction. One of the reimbursement data that will be required to organize Drintic ability to meet quality measures and inform improvements is the use of Six Sigma. Six Sigma is a business strategy that involves improving the designing and monitoring process to minimize and eliminate waste while optimizing patient satisfaction and increasing the financial stability of the hospital. Six Sigma will enable me as a manager of Drintin facility to predict the outcome of future processes and use statistical tools to understand the elements that influence those projections.

Drintin hospital can obtain its source of data from various sources, which will vary in cost, feasibility, accessibility, and accuracy. One of the sources is medical record review, which is a form of retrospective data collection that is useful in providing details on links between interventions and outcomes through offering additional data and elements that are not often available in the administrative database. The limitation that Drintin hospital needs to consider when using this method of gathering their data is the availability of suitable medical records since some of the documents may have been lost and are not within the hospital.

Six Sigma will be utilized by the hospital to improve its operational efficiency related to patient safety and quality care. One of the examples associated with the use of this initiative includes reduction of the variance of the length of stay within the hospital, reduction in waiting time for appointments within the hospital, and elimination of healthcare-associated infections. Through quality care improvement in the hospital, patients and works will be satisfied, and the health facility will gain competitive advantage among its other competing facilities.

How the Use of Reimbursement Data Will Assist the Hospital in Improving Community Needs

The use of reimbursement data to improve health care needs and wellness within the community has become a fundamental element for every hospital to get involved with. More policy environments are offering opportunities to strengthen community needs through cooperation and coordinated efforts (Braveman & Gruskin, 2018). As a manager of Drintin hospital, I have ensured that the facility is not left behind to the growing need to ensure that the health needs of the community around our facility are well catered through the help of reimbursement data. Through the guideline of the affordable care act (ACA) and the process of value-based reimbursements, there is the creation of a framework to assist the community in dealing with their needs and to create community needs health assessments. The use of Validated assessment tools to screen for clinical and behavioral drivers of poor health and needs within the community is one of the reimbursement data that will be needed to analyze population health and identify healthcare services within the community.

Drintin hospital facility can obtain the above reimbursement data through community surveys, surveillance, and medical records. Through the survey, the facility can get reimbursement data through collecting health and social science information from a sample of people within the community using a standardized way to understand a larger population better. Lack of openness and truth among the members of the community in giving their health assessment information where some might lie to receive benefits offered by the facility is one of the limitations the hospital might encounter.

Through the use of reimbursement data, the health and wellness within the community can be improved in various ways. One of the benefits is that society will be able to access health care inappropriately and timely manner. Quality care will improve since the problem of using unnecessary services, resulting in a lack of information, will be solved.

References

Braveman P., & Gruskin S. (2018). Defining equity in health. Journal of epideminiology and community health, 57, 254-258 https://jech.bmj.com/content/57/4/254

Heaton H., (2019). Analysis of the New Jersey Hospital Prospective Reimbursement System: Final report prepared for DHEW under Contract No HEW-OS-74-268. https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.5.2.32

John R., (2018). Health care reimbursement and quality improvement. Published online 2015 May 8. doi: 10.15171/ijhpm.2015.93 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4529047/