Healthcare Recommendations of Payer Mix Payments
If You Were in Charge
As a health services manager with expert knowledge of managed care systems, insurance, and regulations, develop a payer mix goal with objective referenced rationale based on utilization management for a healthcare organization of your choice (real or hypothetical).
The payer mix should:
• Be reported regarding percentages for each patient group receiving services at your specified organization
• Include pros and cons associated with your recommendation to address the recent loss in A/R (money coming in) based on the payer mix payment
• Be based on a list of 10 common services and corresponding payment structures (e.g., make one recommendation if your payer mix payment dropped 20 percent in one-quarter)