Milestone One Guidelines and Rubric Overview:

1 HCM 345 Milestone One Guidelines and Rubric Overview: Much of what happens in healthcare is about understanding the expectations of the many departments and personnel within the organization. Reimbursement drives the financial operations of healthcare organizations; each department affects the reimbursement process regarding timelines and the amount of money put into and taken out of the system. :However, if departments do not follow the guidelines put into place or do not capture the necessary information, it can be detrimental to the reimbursement system. An important role for patient financial services (PFS) personnel is to monitor the reimbursement process, analyze the reimbursement process, and suggest changes to help maximize the reimbursement. One way to make this process more efficient is by ensuring that the various departments and personnel are exposed to the necessary knowledge. Milestone One provides you an opportunity to engage with real -world data that you would encounter in an actual professional environment. Specifically, you will take a closer look at how reimbursement impacts other healthcare departments, and you will dive deep into analyzing the revenue cycle, utilizing data, tracking records, and ensuring compliance within individual departments. Prompt: Submit a draft of Sections = and == of the final project. Specifically, the following critical elements must be addressed: I. Reimbursement and the Revenue Cycle a. Describe what reimbursement means to a healthcare organization. What would happen if services were provided to patients but no payments were received for those services? b. =illustrate the flow of the patient through the cycle from the initial point of contact through the care and ending at the point where the payment is collected. Also identify the departments in order of importance to the revenue cycle. II. Departmental Impact on Reimbursement a. Describe the impact of the departments in a healthcare organization that utilize reimbursement data. What type of audit would be necessary to determine whether the reimbursement impact is reached fully by these departments? :ow could the impact of these departments o n pay -for – performance incentives be measured? b. Assess the activities within each department in a healthcare organization for how t hey may impact reimbursement. What specific data would you review in the reimbursement area to know whether changes were necessary? c. =Identify the responsible department for ensuring compliance with billing and coding policies. :ow does this affect the department ’s impact on reimbursement in a healthcare organization? 2 Rubric Guidelines for Submission : Your paper must be submitted as a three – to four -page Microsoft Word document with double spacing, 12 -point Times New Roman font, one -inch margins, and at least three sources, which should be cited in APA format. Critical Elements Proficient ( 100 %) Needs Improvement (7 5%) Not Evident (0%) Value Reimbursement and the Revenue Cycle:

Reimbursement Comprehensively describes what reimbursement means to a healthcare organization Describes what reimbursement means to a healthcare organization, but description is not comprehensive or contains errors Does not describe what reimbursement means to a healthcare organization 18 Reimbursement and the Revenue Cycle:

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Flow of the Patient Accurately illustrates the flow of the patient through the revenue cycle =llustrates the flow of the patient through the revenue cycle, but illust ration is unclear or inaccurate Does not illustrate the flow of the patient through the revenue cycle 18 Departmental Impact on Reimbursement: Departments Comprehensively describes the impact of the departments that utilize reimbursement data and also influence reimbursement at a healthcare organization Describes the impact of the departments that influence reimbursement, but description is not comprehensive or is not specific to departments that utilize reimbursement data Does not describe the impact of the departments that influence reimbursement at a healthcare organization 18 Departmental Impact on Reimbursement: Activities Assesses the activities within each department at a healthcare organization for how they impact reimbursement Assesses the activities within each department at a healthcare organization but does not explicitly link these activities to reimbursement, or assessment is not specific Does not assess the activities within each department at a healthcare organization for how they may impact reimbursement 18 Departmental Impact on Reimbursement: Responsible Department Correctly identifies the department responsible for ensuring compliance of billing and coding policies and its impact on reimbursement at a healthcare organization =dentifies the department responsible for ensuring compliance of billing and coding policies and its impact on reimbursement at a healthcare organization, but identification is incorrect Does not identify the department responsible for ensuring compliance of billing and coding policies 18 Articulation of Response Submission has no major errors related to citations, grammar, spelling, syntax, or organization Submission has major errors related to citations, grammar, spelling, syntax, or organization that negatively impact readability and articulation of main ideas Submission has critical errors related to citations, grammar, spelling, syntax, or organization that prevent understanding of ideas 10 Total 100%

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