This assignment will require you to consider several influences to the budgeting process of a health care institution. Here, you will review payer mix and other influences to revenue as you consider revenue factors for the budget. Complete the following for this assignment:
For a health care organization of your choice (real or hypothetical), describe the type of organization, and determine the payer mix of patients served (percentage of Medicare, Medicaid, private insurance, managed care, and private pay).
Take into consideration that reimbursement can be affected by the claims process, out-of-network payments, denials, audits, and legislation.
Assess the differences in health care budgeting as a result of these potential changes in the payer mix and payment methodologies as an outcome of the Affordable Care Act.
Take into consideration that while more patients may have insurance coverage, the out-of-pocket expenses will continue to create a potential uncollectable liability.
Evaluate how you would strategize to keep a balanced budget for all 12 months in a year using a flexible budget rather than a static budget, and provide rationale and justification.
The body of the resultant paper should be 5–7 pages and include at least 5 relevant academic or professional references published in the past 5 years.
Differentiate how healthcare regulations federal, local and state increase the complexity of financial management and decision making.
Explain Medicare payment systems, coding, pricing and billing and their impact on financial performance and decision making.