Reimbursement Methodologies in Healthcare

The United States has developed a complex healthcare system. The payment options are among the most important elements of the system. The country offers its citizens and other stakeholders in the healthcare delivery system various options for paying for services. While these options are different, they all seek to distribute the burden of paying for care among all concerned stakeholders (Quinn, 2015). While such institutions as insurance providers and medical facilities are the key stakeholders in healthcare delivery, employers also play a vital role. Across the US, thousands of employers have set up health reimbursement schemes. Through these schemes, employers compensate their employees for the costs that they incur while seeking medical services. The wide range of reimbursement methods clearly helps millions of Americans to access affordable care. Through these methods, medical facilities, insurers and employers are able to join forces with individuals for the purposes of paying for medical services. 

Rationale for choice of topic 

The topic that this project will examine is the reimbursement methodologies in healthcare in the United States. The choice of this topic is deliberate and intended to fill certain knowledge gaps. The main rationale for selecting this topic is to explore the various problems that are encountered in reimbursement. One of the problems that the US continues to face as regards reimbursement is greed among healthcare practitioners and institutions. Physicians, nurses, pharmacists have been accused of colluding to defraud the American people. There have been reports that these practitioners charge their patients for services that are not delivered or are unnecessary (Lee et al., 2016). They do this in an effort to receive more payment for services. The challenge of greed has hampered the delivery of medical services. It appears that medical practitioners have abandoned their mission and are now more concerned with their own wellbeing instead of focusing on safeguarding the welfare of patients. This project seeks to explore how greed impacts reimbursement and the overall delivery of medical services. The project also identifies best practices that can be applied to discourage medical professionals against engaging in greedy pursuits such as overcharging their patients. 

The need to weed out greedy medical practitioners is the primary rationale for the project. In addition to this rationale, the project is also based on the need to understand the impact that the legal landscape in the US has on medical reimbursement. There are various rules, laws and guidelines that govern reimbursement plans. For instance, the Health Insurance Portability and Accountability Act (HIPAA) stipulates that when they set up reimbursement programs, employers should ensure that these programs are in line with the privacy provisions of this act ( “ HIPAA Privacy Rule”, 2014). The privacy provisions of the HIPAA Act apply to such other stakeholders as insurance providers and medical facilities as well. The need for privacy fits neatly into the overall issue that this course examines. The course mainly focuses on health informatics and information management (HIIM). One of the concerns that the management of patient records raises is privacy and confidentiality (Angst & Agarwal, 2009). As they keep patient records, medical facilities face the threat of security breaches that could see them lose sensitive and personal data. This project outlines some of the best practices that medical facilities can adopt as they seek to ensure privacy and confidentiality in their reimbursement programs and patient data management systems. 

Reasons for format 

When carrying out a project assignment, one needs to adopt a format that is in line with the project objectives. For this project, the case study format has been selected. The project will focus on Quantum Healthcare. There are numerous reasons for the selection of case study as the format for the project. One of the benefits of the case study approach is that it allows for an in-depth examination of an issue (Crowe et al., 2011). This benefit informed the decision to select the approach. Using the case study format, it is hoped that a comprehensive, wide-ranging and deep exploration of the various reimbursement methodologies in healthcare will be undertaken. Another benefit that the case study approach delivers is that it allows one to understand how theoretical concepts come to life in real-world settings (Crowe et al., 2011). This course has explored a number of interesting theoretical concepts that concern health records and information management. Through an examination of the practices of Quantum Healthcare, the project will determine how the theoretical concepts learnt in class apply to this organization. That the case study approach allows for practical implications to be established is yet another benefit of this approach (Crowe et al., 2011). When one uses the case study format, they are able to apply the insights that they gather to real situations. The case study approach appears to be the most appropriate format for this project. The project focuses on a real issue that has far-reaching impacts on the delivery of medical services. Therefore, through the case study format, the project will explore how various issues concerning reimbursement relate to the operations of healthcare organizations such as Quantum Healthcare. 

Importance of project to HIIM 

One of the main purposes of this project is to add to the existing knowledge in HIIM. This project is indeed important to health informatics and information management. HIIM is primarily concerned with the collection and storage of such information as patient health records. Today, more and more medical facilities are abandoning traditional paper-based information management systems. They are adopting electronic health records management in an effort to address the flaws in the traditional method (Ben-Assuli, 2015). However, since electronic health records management is a fairly recent development, facilities have been grappling with challenges in their attempts to integrate this health management approach into their operations. For example, privacy concerns continue to discourage the adoption of electronic health records management (Ben-Assuli, 2015). One of the numerous issues that this project examines is the impact that privacy concerns and such laws as the HIPAA have on medical reimbursement schemes. Through its exploration of these issues, this project will expand knowledge in HIIM. 

In a later section of this proposal, some of the best practices for reimbursement in healthcare will be identified. The inclusion of these practices is intended to improve HIIM. As noted above, HIIM grapples with such challenges as privacy concerns. The best practices will identify some of the measures that healthcare providers can institute to improve their health information systems. Therefore, this project is important as it sheds light on strategies that have been established to be effective in enhancing the management of health information systems. 

Problem definition 

Outline 

As it is clear from the discussion this far, the project will explore the various reimbursement methodologies in healthcare. Before delving into a deep discussion on this issue, it is helpful to begin with an outline of the problem that the project will tackle. This project will identify the various methods that employers, insurance companies, the American government and medical institutions use for reimbursement. The project will go further and examine some of the issues that surround the reimbursement methodologies. For instance, the privacy concerns that reimbursement raises and the pitfalls that stakeholders encounter when they adopt a particular reimbursement approach are some of the issues on which the project will shed light. Particular focus will be given to the problem of greed among medical practitioners. Through its focus on these issues, the project will provide medical facilities, employers and medical insurance providers with the insights that they need to improve service delivery and the management of health information. Overall, this project will offer an in-depth discussion on the different reimbursement methodologies that are available. It is important to remember that as it examines these methodologies, the project will attempt to relate them to the practices of Quantum Healthcare. This organization will allow for an understanding of how real organizations use different methodologies for reimbursement and information management. 

Background information 

Greed among practitioners is among the challenges that many healthcare organizations face today. It is true that most practitioners are honest professionals who prioritize the needs of their patients. However, there is a small minority that fails to recognize the importance of integrity and ethical conduct. This minority will receive intense scrutiny in the project. A review of background information concerning greed among practitioners is helpful. The various reimbursement methodologies were developed with the aim of facilitating the payment for medical services. These methodologies range from fee-for-service, prospective payment, cost-based payment, per discharge and per diem to percentage of charge (“KCMU Medicaid Benefits”, 2014). Most organizations have achieved remarkable success in their adoption of these methodologies. However, fraud and practitioner greed have hampered the efforts of some medical facilities to incorporate reimbursement methodologies into their medical delivery systems. It is understood that practitioners engage in a wide variety of dishonest and fraudulent activities. For example, there are some practitioners who falsify documents (Rudman, 2009). They record services and demand payment for these services yet none of the services were delivered. There are other practitioners who collude with such parties as pharmacists to overcharge for medicine and other services (Rudman, 2009). If medical facilities are to be successful in their quest for seamless information management and effective reimbursement processes, they must move with speed and tackle such malpractices as fraud and greed. In addition to causing damage to the reputation of the medical community, these malpractices also pose a challenge to the effective delivery of affordable and quality medical services. 

As will be made clear in a later section, Quantum Healthcare grapples with various challenges that hamper healthcare delivery and reimbursement. Practitioner fraud and the continued use of paper-based records management system are some of these challenges. The facility recognizes that unless it takes action, these challenges will discourage growth. It has instituted a number of measures that are intended to tackle the challenges. In response to practitioner fraud, the facility has set up a board that routinely reviews practitioner conduct. The board is composed of five medical practitioners who represent the different professions at the facility. While the board has had some success, it has largely been ineffective. Its ineffectiveness can be blamed on its small size. It is rather ridiculous for the facility to expect five individuals to monitor dozens of practitioners. Quantum Healthcare has taken some steps to digitize its records management system. So far, the facility has managed to save the records of patients from the last six months. It is yet to digitize records from earlier periods. The slow pace of progress can be attributed to understaffing and lack of commitment. This facility does not fully understand that adopting technology is no longer an option. For any medical facility to survive in the modern era, it simply must embrace technology. 

Possible causes 

The problem of practitioner greed and fraud is serious and could cause the collapse of an entire healthcare delivery system. To solve this problem, it is important to begin with a look at some of the possible causes. The failure by practitioners to honor the code of ethics and conduct is among the possible causes of the problem. Most healthcare organizations have developed clear guidelines which are intended to regulate the conduct of practitioners (Pozgar, 2011). While a majority of the practitioners adhere to these guidelines, there are a few who flout them. Poor pay is another possible cause of greed and fraud among practitioners. The US has made progress in ensuring that medical practitioners are rewarded for their effort and dedication. However, there are some practitioners who do not receive fair or adequate compensation. The low pay that the practitioners receive forces them to resort to such ills as greed and fraud. Therefore, for the US to eradicate these ills, it must invest in the welfare of medical practitioners. 

It is important to remember that healthcare fraud is rare and that most practitioners are passionately dedicated to their mandate. Internal and external pressures are among the forces that push some practitioners into fraudulent activities (Dean, Vasquez-Gonzalez, & Fricker, 2013). For example, some practitioners face financial challenges at home. They resort to fraud and demonstrate greed in a bid to resolve the challenge that they face. The pressure to find success in one’s professional pursuits is yet another possible cause of fraud in healthcare (Dean, Vasquez-Gonzalez, & Fricker, 2013). Nearly all practitioners desire to make progress in their professional lives. While most practitioners work hard to achieve their career goals, there are some who resort to fraud. 

Importance of examination of problem 

The importance of exploring the problem of healthcare fraud in relation to reimbursement cannot be overstated. Every year, the US loses billions in fraudulent schemes (Mangan, 2015). In addition to causing the country to suffer losses, fraud also damages the image of the healthcare profession. Moreover, as a result of fraud, the delivery of medical services is hampered. The examination of healthcare fraud therefore highlights the damages that this ill causes. Another importance of examining this problem is that the examination challenges the concerned stakeholders to take action. For example, with clear understanding of the dangers of fraud, medical facilities can institute measures to discourage their practitioners against engaging in fraudulent activities. Overall, the examination of healthcare fraud raises awareness while allowing for the implementation of solutions. 

Literature review 

Research outline 

Dozens of scholars have investigated and discussed reimbursement methodologies in healthcare. Wulianallur Raghupathi and Viju Raghupathi are among these scholars. Their discussion focuses on the role that big data analytics play in healthcare delivery. One of the key issues that they examine is the function that data analytics serves in reimbursement schemes. They note that medical institutions and insurance providers rely on data to design reimbursement programs (Raghupathi & Raghupathi, 2014). The issues that this duo examines are indeed relevant to the issue discussed in the project. One of the subjects that the project explores is how data analytics can be used to improve reimbursement methodologies and enhance the delivery of care. Therefore, borrowing from the insights that the two scholars share, recommendations about how Quantum Healthcare can integrate data analytics into its operations will be offered . These scholars are not lone voices in their acknowledgement of the role of data analytics in healthcare delivery and information management. Illhoi Yoo and a team of other scholars also authored an article in which they recognize that data analytics is a vital tool for designing effective reimbursement initiatives (Yoo et al., 2012). Their article focuses on number of different issues. However, they give particular emphasis to how medical facilities can rely on patients for information (data mining). Essentially, Yoo and his team suggest that the adoption of data analytics needs not be a costly affair. Patients possess information on a wide range of issues. Using this information, facilities can improve the quality of care that they provide. The relevance of the issues that Yoo and his colleagues address lies in the fact that these issues present implications for Quantum Healthcare. If this facility is to solve the challenges that it grapples with, it must adopt data mining and analytics . Allan Simpao and his colleagues are yet another group of scholars who shed light on the importance of data analytics. They observe that medical institutions that have adopted big data analytics have witnessed performance improvements (Simpao et al., 2014). While these scholars do not explicitly state that data analytics has enhanced reimbursements, it is fair and reasonable to suggest that reimbursement programs have seen vast improvements as a result of data analytics and information management. Quantum Healthcare would benefit immensely when it embraces the insights and tips that Simpao and his fellow scholars provide in their article. Since this article examines the value of data analytics, Quantum Healthcare can integrate the insights into its operations so as to improve the delivery of care while tackling the problems that it faces. Thanks to the insights that these scholars share, one is able to appreciate the importance of data analytics and information management in the delivery of medical services. 

The various reimbursement programs that are available have receive intense scholarly examination. Quinn (2015) looks at some of these programs. Fee-for-service, global payment, capitation and cost reimbursement are some of the methodologies used to reimburse for medical services (Quinn, 2015). Quinn and his team discuss each of these reimbursement methodologies in detail. They also give some attention to the evolution that the methodologies have undergone and the forces responsible for this evolution. Quinn’s article has been included in the review because of its relevance. The project discusses the various reimbursement methodologies in use at Quantum Healthcare. Using Quinn’s article, it is possible to offer a theoretical foundation for the project. Essentially, Quinn’s piece allows one to better understand the different approaches that medical facilities use for the purposes of reimbursement. Traditionally, physicians and medical facilities bill patients based on the volume of services delivered. The government and insurers also use the volume of services as the basis for determining the amount to reimburse (O’Donnell, Williams, & Kilbourne, 2013). O’Donnell and his colleagues highlight how an increasing number of service providers are embracing quality-based payment systems. These facilities have renewed their commitment for quality care. This project aims to help Quantum Healthcare adopt more effective reimbursement methodologies. The article by O’Donnell and his colleagues accelerates the attainment of this goal. Thanks to this article, the project will propose that Quantum Healthcare should adopt reimbursement methodologies that promote patient wellbeing and reward practitioners for their commitment to quality service delivery. While many facilities and practitioners still use the traditional volume-based methodologies, new approaches are emerging. For example, the Affordable Care Organizations (ACOs) model has introduced a new dispensation where facilities and practitioners seek reimbursement based on the quality of services that they offer (Rajkumar, Conway, & Tavenner, 2014). Rajkumar, Conway and Tavenier offer an interesting discussion on the far-reaching impacts that the ACOs model has had on healthcare delivery. They particularly note that the adoption of this model has facilitated reform. It has challenged medical facilities to move away from inefficient models and embrace the ACO model. The relevance of this article to the project is undeniable. As already pointed out, one of the aims of the project is to identify the strategies that Quantum Healthcare can adopt to improve care and its reimbursement methodologies. The ACOs model is one of these strategies. The implication of this new model is that the better the quality of services offered, the higher the reimbursement. The ACOs model and the resulting reimbursement methodology challenges practitioners and institutions to place greater focus on quality instead of volume (Fisher et al., 2009). Fisher and his team echo the sentiments that other scholars have expressed. They reiterate that the ACOs model is hugely beneficial. Thanks to this model, practitioners, patients and facilities have witnessed tremendous benefit. This article has been selected because it adds weight to the arguments that such scholars as Rajkumar and his team raise. Fisher and his colleagues provide an even more solid basis and rationale for advising Quantum Healthcare to embrace the ACOs model. Furthermore, thanks to the adoption of this model, practitioners have enhanced collaboration while reducing the cost of delivering care (Pham, Cohen, & Conway, 2014). Pham, Cohen and Conway add their voice to the discussion on the ACOs model. They focus on how this model has challenged medical practitioners to join forces so as to safeguard patient wellbeing. Relying on the arguments that this trio presents, the project will urge Quantum Healthcare to move with speed and join the many medical facilities that have already adopted the ACOs model. The discussion on these methodologies would be incomplete without a look at the important role that reimbursement plays. In their article, Seung Jun Lee and his fellow scholars acknowledge that reimbursement “ remunerate healthcare organizations, physicians and patients” (Lee et al., 2016, p. 71). Through the various reimbursement methodologies, practitioners and medical institutions receive payment for the medical services that they deliver. Lee and his team examine a vital issue. Their discussion goes into the very heart of the project. The project focuses on reimbursement methodologies while their discussion explores these very same methodologies. This convergence facilitates the development of the project. The project borrows from the article in its discussion on the roles that reimbursement methodologies play. Reimbursement also compensates patients for the costs that they incur while seeking treatment (Clemens & Gottlieb, 2014). While Lee and his team identify the various roles that reimbursement plays in the lives of practitioners, Clemens and Gottlieb focus their attention on the benefits that the methodologies deliver to patients. They note that the methodologies provide patients with an avenue for receiving compensation. Essentially, Clemens and Gottlieb suggest that reimbursement is more than a mere process for paying practitioners. It also bolsters fairness and equality. The project will derive immense benefits from the discussion that Clemens and Gottlieb offer. Their discussion will serve as the basis for calls for Quantum Healthcare to adopt better measures as part of its reimbursement process. Overall, reimbursement is a critical element of healthcare delivery as it enables institutions and practitioners to obtain the funds that they need to continue offering services. 

The review of the literature above has revealed that there are various reimbursement methodologies which serve a number of critical functions. This review has also highlighted the changes that reimbursement is undergoing. An increasing number of healthcare providers are moving away from the traditional volume-based approaches and adopting methodologies that place focus on value and patient satisfaction. As was pointed out in an earlier discussion, fraud is one of the hurdles that medical service providers face in reimbursement. Practitioners and facilities engage in fraudulent activities which erode trust in the medical profession. Apart from painting the medical profession in negative light, healthcare fraud also causes harm to patients (Joudaki et al., 2015). Joudaki and his colleagues argue that patients suffer financial harm as they are robbed. They add that fraud among practitioners hurts the physical wellbeing of patients. The negative impacts of fraud and greed among practitioners cannot be ignored. Joudaki and his team supply information that will form the bulk of the discussion on the impacts of health fraud. This discussion will be included in the project. This ill has made it incredibly difficult for the profession to focus all its efforts and resources on enhancing patient outcomes. For sustainable progress to be made, healthcare providers need to take all necessary steps to combat fraud. 

The fact that health fraud causes damage cannot be disputed. To aid institutions and physicians in their quest to eradicate fraud, various best practices have been developed. The implementation of mechanisms for detecting fraud is among these practices. Using data analytics, medical institutions can monitor reimbursement patterns to detect fraud (Abdallah, Maarof, & Zainal, 2016). Abdallah and his fellow scholars offer a practical suggestion that medical institutions can use to end the problem of fraud. They advise that such facilities as Quantum Healthcare should seek to detect fraud and minimize its impacts. This suggestion is indeed sound. For Quantum Healthcare to effectively tackle greed and fraud among its practitioners, it should adopt data analytics. The fact that the article that Abdallah and his colleagues authored has practical implications for medical facilities is the main reason for its inclusion in the review. Adopting such models as the ACO is another best practice that can shield medical facilities against health fraud. This model encourages practitioners to focus their resources and efforts on delivering quality care. Instead of charging for services not delivered, practitioners offer excellent services for which they receive fair and adequate compensation. Ensuring that all services that are delivered are medically necessary and medically reasonable is yet another best practice that enhances reimbursement programs (Niemtzow et al., 2013). Niemtzow and his team make a point that should be clear and obvious. They challenge practitioners to avoid offering services that are only intended for enrichment and add little value to the wellbeing of patients. Quantum Healthcare should heed the call that these scholars issue. The benefits that the facility is set to enjoy upon the adoption of the strategies that Niemtzow and his colleagues propose are the primary basis for the selection of the article. As part of their efforts to tackle fraud, healthcare providers should also adhere to guidelines and laws such as the Affordable Care Act ( “ 10 Best Practices for Premium”, 2014). This article broadens the discussion on how medical facilities can improve care. The article identifies a number of best practices that promote efficiency and effectiveness in reimbursement. Of particular importance is the practice of complying with legal provisions and ethical guidelines. Quantum Healthcare needs to call on its practitioners to follow their law in all their endeavors. As it does this, it will be positioning itself to become a trusted provider of quality medical care. Ethics and value-based practice is yet another best practice for improving reimbursement and curbing fraud (Ogunbanjo & Bogaert, 2014). Ogunbanjo and Bogaert conclude the review. They remind medical facilities of the importance of value-based practice. Practitioners should derive their drive from a desire to help patients instead of enriching themselves. They need not rely on formal guidelines. They should simply develop personal belief and value systems which govern their conduct. Overall, patient-centric approaches hold the promise of improving healthcare and minimizing cases of such ills as healthcare fraud. Therefore, medical institutions should aggressively implement reforms that discourage greed while challenging practitioners to deliver quality services. 

Summary of literature 

The literature review above has examined a number of important issues. It has established that reimbursement is a vital pillar of medical service delivery. Thanks to reimbursement, practitioners and facilities are paid for their services. Reimbursement also allows patients to receive back the money that they pay for treatment. Another issue that the literature review has highlighted is the important role that data analytics and information management plays in facilitating reimbursements. As they adopt data analytics, healthcare providers are able to rely on data to claim reimbursements and crack down on fraud. Best practices that promise to improve reimbursement are another issue that the literature review has explored. These best practices range from the adoption of the ACOs model to the integration of fraud detection mechanisms. As they embrace these best practices, physicians and medical institutions will be successful in their fraud-eradication initiatives. 

The purpose of this project was to explore various reimbursement methodologies. The literature review offered above is a step towards the accomplishment of this purpose. The review addresses the role of reimbursement in healthcare delivery. Additionally, this review looks at the different reimbursement methodologies that healthcare organizations can use. The different issues that the review examines are directly related to the purpose of the project. Through the review, a theoretical framework for the project has been established. This framework entails the insights and perspectives that different scholars have shared. The final project will borrow from the extensive and thorough literature review to add to the existing knowledge on reimbursement methodologies and their effect on healthcare delivery. 

References 

10 Best Practices for Premium Reimbursement. (2014). Retrieved 1 st March 2018 from https://www.zanebenefits.com/blog/best-practices-premium-reimbursement 

Abdallah, A., Maarof, M. A., & Zainal, A. (2016). Fraud Detection System: A Survey. Journal of Network and Computer Applications, 68, 90-113. 

Angst, C. M., & Agarwal, R. (2009). Adoption of Electronic Health Records in the Presence of Privacy Concerns: the Elaboration Likelihood Model and Individual Persuasion. MIS Quarterly, 33 (2), 339-370. 

Ben-Assuli, O. (2015). Electronic Health Records, Adoption, Quality of Care, Legal and Privacy Issues and their Implementation in Emergency Departments. Health Policy, 119 (3), 287-297. 

Clemens, J. C., & Gottlieb, J. D. (2014). Do Physicians’ Financial Incentives Affect Medical Treatment and Patient Health? American Economic Review, 104 (4), 1320-49. 

Crowe, S., Cresswell, K., Robertson, A., Huby, G., Avery, A., & Sheikh, A. (2011). The Case Study Approach. BMC Medical Research Methodology, 11 (100). Retrieved 1st March 2018 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3141799/pdf/1471-2288-11-100.pdf 

Dean, P. S., Velasquez-Gonzalez, J., & Fricker, L. (2013). Causes and Challenges of Healthcare Fraud in the US. International Journal of Business and Social Science, 14 (14), 1-4. 

Fisher, E. S., McClellan, M. B., Bertko, J., Lieberman, S. M., Lewis, J. L., & Skinner, J. S. (2009). Fostering Accountable Health Care: Moving Forward in Medicare. HealthAffairs, 28 (2). DOI: https://doi.org/10.1377/hlthaff.28.2.w219 

HIPAA Privacy Rule- What Employers Need to Know for Section 105 Reimbursement Plans. (2014). Retrieved 1 st March 2018 from 

https://www.zanebenefits.com/blog/hipaa-privacy-rules-and-section-105-reimbursement-plans 

Joudaki, H., Rashidjan, A., Minaei-Bidgoli, B., Mahmoodi, M., Geraili, B., Nasiri, M., & Arab, M. (2015). Using Data Mining to Detect Health Care Fraud and Abuse: A Review of Literature. Global Journal of Health Science, 7 (1), 194-202. 

KMCU Medicaid Benefits Database: Definitions for Frequently Used Reimbursement Methodologies. (2014). Retrieved March 8, 2018 from 

https://kaiserfamilyfoundation.files.wordpress.com/2014/02/kcmu-medicaid-benefits-database-definitions-of-frequently-used-reimbursement-methodologies.pdf 

Lee, S. J., Abbey, J. D., Heirn, G. R., & Abbey, D. C. (2016). Seeing the Forest for the Trees: Institutional Environmental Impacts on Reimbursement Processes and Healthcare Operations. Journal of Operations Management, 47-48, 71-79. 

Mangan, D. (2015, March 19). Give it back! $3.3 Billion Recouped from Health Scammers. Retrieved 1 st March 2018 from https://www.cnbc.com/2015/03/19/us-recoups-33-billion-from-health-care-fraud.html 

Niemtzow, R. C., Sager, M., Cooke, P., Michelfelder, A., & Safayan, A. (2013). Insurance Reimbursement: An Expert Discussion on Best Practices and Avoiding Pitfalls. Medical Acupuncture, 25 (6), 376-385. 

O’Donnell, A. N., Williams, M., & Kilbourne, A. M. (2013). Overcoming Roadblocks: Current And Emerging Reimbursement Strategies for Integrated Mental Health Services in Primary Care. Journal of General Internal Medicine, 28 (12), 1667-1672. 

Ogunbanjo, G. A., & Bogaert, K. (2014). Ethics in Health Care: Healthcare Fraud. South African Family Practice, 56 (1), S10-S13. 

Pham, H. H., Cohen, M., & Conway, P. H. (2014). The Pioneer Accountable Care Organization Model. Improving Quality and Lowering Costs. JAMA, 312 (16), 1635-1636. 

Pozgar, G. (2011). Legal Aspects of Health Care Administration. Jones & Bartlett Publishers. 

Raghupathi, W., & Raghupathi, V. (2014). Big Data Analytics in Healthcare: Promise and Potential. Health Information Science and Systems, 2 (3). DOI: 

10.1186/2047-2501-2-3 

Rajkumar, R., Conway, P. H., & Tavenner, M. (2014). CMS-Engaging Multiple Players in Payment Reform. JAMA, 311 (19), 1967-1968. 

Rudman, W. J. (2009). Healthcare Fraud and Abuse. Perspectives in Health Information Management, 6. Retrieved 1 st March 2009 from 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2804462/ 

Simpao, A. F., Ahumada, L. M., Galvez, J. A., & Rehman, M. A. (2014). A Review of Analytics And Clinical Informatics in Health Care. Journal of Medical Systems, 38 (45). DOI: https://doi.org/10.1007/s10916-014-0045-x 

Quinn, K. (2015). The 8 Basic Payment Methods in Health Care. Annals of Internal Medicine, 163 (4), 300-6. 

Yoo, I., Alafaireet, P., Marinov, M., Pena-Hernandez, K., Gopidi, R., & Hua, L. (2012). Data Mining in Healthcare and Biomedicine: A Survey of the Literature. Journal of Medical Systems, 36 (4), 2431-48.