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Maxwell Anyone
SNHU Health Administration
April 16, 2023

This is an example of how you can put your white paper together. You can make up your own headings
and put graphics or charts wherever you want. I have translated what the rubric states and put it into
questions and suggestions under each heading.
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TABLE OF CONTENTS
About This Hospital 2
What is Reimbursement? 2
The Revenue Cycle 2
The Flow of the Patient Through the Revenue Cycle 2
Use of Reimbursement Data 3
Departments and Activities That Affect Reimbursement 3

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Overall Responsibility for Compliance 3
Third Party Payer Policies 3

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Payer Mix 3
Key Areas of Review in Reimbursement 3
Follow-up on Claims Status 4
Periodic Review of Compliance with Coding and Billing Regulations 4
New Managed Care Contracts 4
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Staying Current with Regulations 4
Ethical Standards 4
Conclusion or Key Takeaways 4
References 5
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About This Hospital

In a few words, say what you are writing about. Give a little background: what hospital are you
from, and what is your role (Patient Financial Services Supervisor).

What is Reimbursement?
Briefly say what reimbursement is and why it is important to your hospital. What would happen
if the hospital did not get paid?

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The Revenue Cycle
Talk about the revenue cycle and how it leads to reimbursement. You may want to describe the
steps in the revenue cycle, from when it starts until when it ends.

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This is where some students feel an illustration would help understanding.
Use charts, tables, or images to help show what you are talking about. Discuss the elements
in your chart (don’t just show a picture and not write anything about the topic.)
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Figure 1: What is this supposed to show? Where did you get it?

The Flow of the Patient Through the Revenue Cycle

Briefly show the patient’s flow through the cycle, indicating where the patient is involved.
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You can use an illustration here (or anywhere), but make sure you discuss the importance of the
patient at key stages of the cycle.

Use of Reimbursement Data

How is reimbursement data used? Who uses it? Think about planning, staffing, which payers
are denying your claims…

Departments and Activities That Affect Reimbursement

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Which departments are important to reimbursement?
Remember that hospitals have departments such as Registration or Admissions, Finance or
Billing, Health Information Management, Clinical Services (like doctors and nurses), DIagnostics

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Services (like labs and x-rays), and Administration in charge of everything. You can also have
Case Management to make sure the patient’s care is well-coordinated, and any others you want
to mention.
Briefly describe what the departments you name do contribute to reimbursement/the revenue
cycle.
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Overall Responsibility for Compliance
Who has overall responsibility for assuring that everything is done according to rules and
regulations? You can also describe the other main departments that help with this.

Third Party Payer Policies

Talk about the type of payers and how they each have different rules or ways of paying for care.
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How does this affect how you design your own billing procedures?
Payer Mix
Define payer mix. How does the way different payers reimburse you (fee for service or
prospective payment, etc.) affect how you decide which insurers to work with?

Key Areas of Review in Reimbursement

How do you make sure claims are being prepared and submitted correctly? Which departments
and activities are the most important for you to review regularly? List them in order of
importance in your opinion and say why. You can use a bulleted list if it makes it clearer.
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Follow-up on Claims Status

How do you set up your staff to follow up on the status of claims you submitted? Which staff
will you use, and how often will they do follow-up? If a claim is denied, who does your staff
work with to appeal the denial, or make any corrections that are needed? (This section is not
about following up on how patients are feeling or future appointments.)

Periodic Review of Compliance with Coding and Billing Regulations

Describe how you will review work to make sure it is compliant with coding and billing rules.
How often will you do this review? What staff will do the review?

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New Managed Care Contracts

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Why is a new managed care contract important to the hospital? Why does the hospital have to
review it carefully before signing? Think about your payer mix.

Staying Current and Compliant with Regulations

Who in the organization makes sure that your hospital is up to date with all regulations? How is
everyone told about changes? What resources (human or other) are needed for compliance?
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Ethical Standards
Name your stakeholders. How are they told about ethical standards? You can mention
regulations that apply to this topic. What happens if a breach of ethics is discovered?

Conclusion or Key Takeaways (if you want to add these)

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Do you want to wrap this up in a few sentences or do you want to sum this paper up in just a
few bullet points?
● Takeaway #1
● Takeaway #2
● Takeaway #3
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References

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