Successful Billing Strategies in the Hospital Industry

• Main Author: Merritt, Samirah
• Format: Others
• Language: en
• Published: ScholarWorks 2019
• Subjects: Billing; Complexity Theory; Medicare; Value Based Payments; Health and Medical Administration
• Online Access: https://scholarworks.waldenu.edu/dissertations/6621; https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=7900&context=dissertations

Failure to collect reimbursement because of changing regulations negatively impacts hospital profitability. A multiple case study approach was used to explore the successful strategies billing managers employed to collect reimbursement for all legitimate Medicare claims. The target population for this study included 5 hospital billing managers from 3 organizations in the Northern New Jersey region. The complexity theory was used as a framework for assessing changing Medicare regulations and how the managers adapted to them. The data collection process for this study involved gathering data from participant interviews, documentation from the organizations of the participants, and government documented regulations and manuals. The logical and sequential order of data analysis for this study embraced Yin's 5-steps data analysis that includes compiling data, disassembling data, reassembling data, interpreting the data, and concluding. The successful strategies billing managers used that emerged as themes were remaining up to date with Medicare changing compliance regulations; enhancing communication with staff, multiple departments, and Medicare; and adopting a robust billing system and other systems that compliment billing. The implications of this study for social change include the potential to ensure access to patient care for benefiting families and communities through the sharing of successful strategies for Medicare claims.