Operating Bugject Proposal

Operating Bugject Proposal

Preparation

Imagine yourself in the role of a risk manager. Select a topic related to risk financing and identify a risk financing issue. This issue may be from a selected organization or from your workplace. As an example, you might select the issue of financing potential malpractice suits at a medical clinic. Refer to the Suggested Resources to ensure that you have a solid understanding of the financial dynamics related to this type of issue.

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Instructions

Memo – Risk Financing Issue
Create a 2– 3-page internal memo. Follow the steps below and include them in the memo:

Concisely describe the issue and the organization.
Summarize the legal and ethical financial risk obligations of an ACO.
Describe how you would identify and manage risk financing issues within this organization. Support your choice of strategies with relevant resources.
Recommend two or three of the best options for risk financing for this issue, as it relates to the organization in question.
Include at least three APA-formatted in-text citations and accompanying congruent APA-formatted references. Your sources can be a course textbook, assigned reading, or any other scholarly source.
Additional Requirements
Written communication: Written communication should be free from errors that detract from the overall message.
Memo format: Format your memo so that it reflects the professional standards of your organization or accepted standards of a professional memo in the industry.
Length of paper: 2–3 double-spaced pages for the written portion of the assessment.
Number of resources: A minimum of three resources.
Font and font size: Times New Roman, 12 point.

Name of  Organization

Memo

To:
From:	YOUR NAME HERE PLEASE MHA5014-FPX – Assessment 2
cc:
Date:
Re:

Identified Risk Performance Indicators and Measures

[Identify key performance indicators and measures associated with a specific risk-management issue.]

Strategies Used to Identify Risk Financing Issues

            [Discuss strategies used to identify risk financing issues in selected organization.]

Recommendations for Risk Financing Options

            [Provide recommendations for risk financing options related to an identified financial risk issue.]

Legal and Ethical Financial Risk Obligations

            [Summarize the legal and ethical financial risk obligations of an accountable care organization.]

 

 

References

 

MORE INFO 

The legal and ethical financial risk obligations of an ACO.

Introduction

The ACO model has been around for a long time, but it is only recently that the Centers for Medicare & Medicaid Services (CMS) began regulating this type of organization. As such, there are still some gaps in understanding how an ACO functions and what its legal and ethical financial risk obligations are. Below we’ll explore those gaps and provide guidance on how to meet these requirements:

ACO regulation.

In the United States, ACOs are regulated by CMS. While this may not seem like a big deal at first glance, it can be confusing for many people who have no experience with healthcare regulation or Medicare.

CMS has a number of rules that ACOs must comply with:

• Clinical risk adjustments (CRAs) – CRAs are used to calculate payments for hospitals and other providers based on how much care their patients needed rather than what kind of care was provided (e.g., whether it was surgery or chemotherapy). CMS reviews all proposed CRAs before they’re implemented to ensure compliance with certain criteria; if an insurer receives negative feedback from CMS about one of its proposed CRA rates then that insurer must submit another proposal with changes made accordingly within 30 days of receiving notification from CMS regarding approval or disapproval status.*

ACO policies.

• ACO policies should be based on the needs of the population they serve.

• ACO policies should be communicated to all stakeholders.

• ACO policies should be reviewed regularly and revised as necessary.

• ACO policies must comply with Medicare regulations, including those for quality improvement and patient safety, which require that care be provided in a safe environment without compromising patient safety or quality of care (for further information on these requirements see: https://www3.cmsginc.org/Resources/GuidanceDocuments/Medicare+Quality%20Initiatives%20and+Standards).

ACO financial risk thresholds.

You should be able to manage your financial risk without relying on the risk adjustment program or Medicare Shared Savings Program.

The ACO financial risk thresholds are:

ACO obligations and past performance.

ACOs are required to do more than just participate in a program. They must also be financially accountable for their decisions and actions, which means that they need to have clearly understood financial risk obligations.

As an ACO, you will be responsible for managing the financial risks associated with your programs and plans. You could face significant fines if you don’t meet these obligations — or worse! It’s important that everyone involved understands these policies well ahead of time so there aren’t any surprises when it comes time for assessment or audit purposes.

Complying with Medicare’s rules on participant agreement terms.

Medicare’s rules on participant agreement terms are fairly straightforward and easy to comply with:

• You must provide a copy of your participant agreement to each prospective beneficiary before they sign up for services. This includes individuals who need coverage under the Medicare Advantage program and those covered by stand-alone prescription drug plans.

• Your compliance with these rules can be checked by comparing the language in your contract with that found in federal regulations (42 CFR § 404.1511).

The legal and ethical financial risk obligations of an ACO should be communicated to all stakeholders involved in the accountable care organization model.

The legal and ethical financial risk obligations of an ACO should be communicated to all stakeholders involved in the accountable care organization model. This includes:

• A clear understanding of their financial risk obligations, including who is responsible for payment and collections, how much money they must pay out each month and whether or not they can raise prices (if so, what will happen if their members don’t agree).

• A clear understanding of their legal and ethical obligations (including laws governing privacy), as well as a description of how those laws apply to your practice’s practices—for example, if you store patient data on any cloud services providers that may be used by third parties other than yourself; whether or not you’ve complied with HIPAA regulations; and whether or not there are any state licensing rules that apply directly to your business operations.

Conclusion

It is important for ACOs to understand the legal and ethical financial risk obligations of their organization. If a health plan or other entity is not informed about these obligations, then it may cause the ACO to have an inaccurate perception of its own financial risks and shortfall or insolvency. As a result, they may act in ways that are not in the best interest of patients or physicians. For example, if there are no financial risks associated with a particular project, then it may be tempting for an ACO to pursue that project even if it would put them at risk financially. On the other hand, if you don’t know what your obligations are as an accountable care organization (ACA), then it could cause legal problems down the road when things go wrong later on down line (e.g., members sue over losses from ACO lawsuits).