The change is an evitable process, especially in cooperate or business set-up. The organizational change occurs when there is a need for improvement or efficiency in the functioning of an organization is required (Weiss, 2016). It is either the total renovation of the whole system, or just the relevant department is changed. The organization highlighted in this paper will be the healthcare industry, as there are specific challenges related to this organization related to providing coverage of the medical assistance, along with the physician's recruitment in the company. This paper will explore the changes needed in the process of medical insurance overpayment while utilizing Kotter’s 8-Step approach, besides providing the overview of the company, diagnosis and the application of these 8-steps to the transformational needs.
Company Overview
The situation issue identifies with the medicinal services insurance agency preparing claims where most of the cases are reported to be overpaid. The doctor needs to remove time from providing services to their patients and manage the accounts and billing information by transferring back the installments which are over-paid (Ekin, Musal, & Fulton, 2015). Majorly, the doctors are unaware of the processes for sending back the excessive payments, for this matter, the over installment is sent to the insurance agencies of healthcare organizations. For processing the unknown or obscure larger installments, there is the need for creating a distinct department inside the office of accounts to cater to the overpayments being transferred into the insurance companies of healthcare organizations.
According to many surveys, the insurance agency of healthcare industry is assigned specific representatives for carrying out the management of obscure over installments and discover the range of reasons which are related with the issue of over installments (Green, 2018). The supervisory group at the medicinal services insurance agency chooses to roll out real improvements for decreasing the measure of obscure over installments that backs off efficiency to handling claims by the correct grid and paying doctors precisely. Change in case handling is essential to lessening discounts to doctors, discounting patients, and confine human services protection specialists to not over-quote legally binding payouts.
Diagnosis
Diagnosis is to identify the core issue and providing the best possible solution for it. Such that in the case of insurance coverage for the healthcare industry, the four central contributors for the overpayments are; patients, billing companies, doctor/healthcare provider and the payer (third party). Each of the contributors affects the overpayment in diverse manners, causing the occurrence in various situations. The situations identified include the incorrect information of the patient’s demographics, misestimate the deducting amount, claiming the amount to wrong accounts, payment rates are incorrectly used, or receive double payments. Investing and uprooting the correct cause is not an easy task in the vast and colossal healthcare industry (Hornstein, 2015).
As per modern electronic era, the installments usually are discarded altogether into a substantial electronic investment reservoir, the over installments in these banks end up challenging for differentiating and dealing accurately, especially when there is the onset of bulk payments during the top rush season. This extra constraint and pressure of entering the bulk of new payments is the common reason of organizational mismanagement in billing out the payment. This further aggravates the situation where the return of overly charged payments and dues is lesser prioritized, and it makes the neglected stock of payment to grow wildly. This is a continuous and repetitive process, and almost inevitable.
Classifying and Compensating the Overpayments
Special agreement guidelines for billing organizations were issued in1998 by the OIG. According to the manual, OIG allotted for charging organizational obligations regarding distinguishing and helping the customers in exchange for excessive charges. Being a charging organization, they are entrusted with working with customers to research anything they may know to be inaccurate, which incorporates the examination of excessive charges. In the event that proof of wrongdoing (e.g., unreported excessive charges) is found with respect to one of the customers, the OIG traces a legitimate starting reaction:
•Refrain from presenting those cases that seem faulty.
•Notify customer recorded as a hard copy inside 30 days of finding the flawed installment.
•Work with the customer to agreeably resolve the presumed wrongdoing.
In the wake of finishing these means, the OIG prompts that extra activity might be required if the customer's offense proceeds and takes a move in the direction of the purposeful or deceitful. For this situation, the OIG teaches you to complete one of the accompanying three things:
• Refrain from presenting any false or improper cases.
• Terminate your agreement with the said customer quickly.
• Report the offense to the fitting government or state experts no later than 60 days in the wake of distinguishing valid proof of infringement or by the date on which a relating cost report was expected.
For a long time, this direction set the standard for charging organizations.GOVERNMENT REPAYMENTS – THE FINAL RULE
Be that as it may, when the Affordable Care Act was passed in 2010, it made an express obligation that individual and institutional social insurance suppliers report and return "excessive charges" got from Medicare or Medicaid to the legislature "by the later of" 60 days after the date on which the excessive charge was "recognized" or by the date on which a comparing cost report was expected.
This detailing prerequisite turned out to be generally known as the 60-Day Rule, yet there were various unanswered inquiries identifying with the ideas of "distinguishing" an excessive charge and what an individual must do when it ended up mindful of an excessive charge.
Protection Overpayment Recovery
Luckily, PRP can deal with these touchy cases with a firm and viable hand. We've been overseeing protection excessive charge accumulations in Minnesota for over ten years.
Above all else, our need is keeping up our customer's associations with their patients or suppliers. We comprehend why it is essential to have an accumulation office that can be a successful man in the center to gather cash owed. It's challenging to remain proficient and still be firm enough to get the obligation settled individually. At the point when PRP ventures in, you can rest guaranteed we will achieve the errand without disjoining your valuable customer relationship. Our group has the reputation to demonstrate our accumulation strategies work, and our customer's tributes represent themselves. Hands down– nobody recuperates cash owed as we do.
We emerge from the challenge as a result of our creative programming that permits customers and patients simple access to accounts and advantageous installment alternatives. This increments both our prosperity rate and our customer fulfillment. Our group has accurate information about current Minnesota gathering laws and entirely holds fast to them. We are predictable and kind to our customers, yet extreme enough to get what you are owed.
Pick Professional Recovery Personnel for Insurance Overpayment Collections
Protection guarantee discounts are not for the swoon of heart. Try not to pick a beginner to deal with these debts– pick PRP! The experience, manner, and results set miles ahead from every other person. We will be your voice and act quickly for your benefit. We have the group that utilizes the solid arm to get what is YOURS! Despite why the excessive charge happened, let us settle it for the last time.
Kotter's 8-Step Approach
Stage 1: Generate Necessity
If an entire organization truly needs the changes, then it is inevitable to occur. According to this step, the feeling of necessity around the changing vicinity is built by the internal and external factors (Musal, & Ekin, 2017). This enables to establish the fundamental inspiration of getting things started and doing things related to the poor measurements dealings or arguing over the expanded challenges. Furthermore, it releases a legitimate and persuasive dialogue about what's going on in the market segment and with the competitors. There are certain chances that various groups of people begin to discuss the changes proposed, within the organization and even to the extended competitive market (Pollack, & Pollack, 2015).
Following are the prerequisites for carrying out this process:
•Identifying the impending threats and creating the situation for future predictions
•Observing the potential loopholes which could be misused
•Doing legitimate dialogs, and providing motivations
•reinforcing the contentions by the support from clients, staff, and market partners
Stage 2: Structuring a Powerful Alliance
This step begins by persuading the people that transformation is essential, especially in the organization. This is carried out by taking firm and strong supervision help from famous and talented individuals in the organization. Just managing the change is not enough, it is needed to be supervised and lead by an influential figure of the organization. The pioneers of the organization are perfect for this role, as they know all the details about the organization and its history (Weiss, 2016). For leading the change, a unified or robust alliance, or group, comprising of credible persons who are persuasive and controlling the collection of resources, including status, designation, ability, and political significance. After reshaping the transformational alliance, it is needed to work together as a group, proceeding to assemble and ensure the necessities and optimal speed which is required by the process of change.
Following are the prerequisites for carrying out this process:
•Identifying the authentic pioneers as crucial partners in the organization
•Assuring the passion and responsibility in these individuals
•Work in groups and unified form
•Supervising the individuals and keeping a check and balance and tracking the transformational change and speed over the course of time
Stage 3: Generating a Vision for Transformation
This step is the connection of the transformational thoughts to a broad vision that individuals are trained and passionate enough to grasp the change and effectively implement it in and outside of the organization (Pollack & Pollack, 2015). For ensuring the creation of this vision, there is the necessity of a transparent and translucent guideline regarding the change proposed. When the other employees in the organization see the implementation of the said vision, they ultimately boost up their morale and start to reshape themselves according to the aim of the organizational transformation.
Following are the prerequisites for carrying out this process:
•Determining the qualities integral to implementing the change.
•Developing a short synopsis of the vision determined
•Creating a technique for executing the vision.
•Giving a short presentation or synopsis regarding the vision
•Practicing and discussing the vision frequently also helps
Stage 4: Communicate the Vision
After making and creating the vision, it is necessary to implement the set directions as it will decide the success of transformation. The message of the organization's transformational vision will presumably have a firm challenge from all the competitive sides, whether it is the resistance within the organization or outside the organization. Communicating the facts and figures and the ultimate need for this transformational vision clears the misconception and gives a bright idea to the people opposing or negating the idea. By utilizing the ideas and explaining it through communication and discussion, it will enable the proposed idea to get clearly into the ambiguous minds, and then the way to its prosperity will increase by lesser numbers of the people in opposition to this vision.
Following are the prerequisites for carrying out this process:
•Communicating and discussing the change vision frequently
•Addressing the worries and tensions of the people, openly and genuinely
•Applying the vision to every side of the activity, i.e., from preparing to executing the surveys
•Leading by set standards
Stage 5: Removing hurdles
For proceeding further in accomplishing the set change or transformation in the organization, it is necessary to avoid or eliminate the hurdles and ambiguities coming in the way. The opposition to change is inevitable, and it cannot be eliminated from the start, everyone has its own perceptions and rulings so, the arguments are expected in this system of change and are unavoidable. For this, a setup or structure should be put into practice for a change, and consistently check for boundaries regarding the process. Expelling barriers would encourage the public to execute the vision, and enabling the change for carrying ahead.
Following are the prerequisites for carrying out this process:
•Identifying, or taking the leaders on contract, who is responsible for conveying the change.
•Setting up the hierarchal structure and maintaining the order in the organization
•Recognizing and rewarding individuals who are putting much effort into continuing the change process
•Helping the opposing individuals to see the benefits of the transformational process
• actively evacuating any potential threat or challenge to the transformation
Stage 6: Creating Short-Term Goals
Progress is maintained through continuous procedural steps, no matter how small these steps are they should be ongoing without any disruptions or hurdles. By creating a concise outline, the small steps or milestones should be set and covered with close deadlines. If this step is not followed adequately, the people opposing the change and competitors not happy with the success of the vision will get the chance to negate the change and speak against the process, finding shortcomings. For this step, the momentary targets should be set, not just the only objective set in the long run. Every loophole and ambiguity must have a way out, so the backup plan or plan-B is essential in this step. The change group may need to buckle down to fabricate these objectives, yet each successful step, no matter how minor it is, will inspire the whole organization.
Following are the prerequisites for carrying out this process:
•creating the baby steps, and setting a milestone for each step
•legitimating the steps and enforcing it on the whole organization with the power
•Thoroughly investigating the advantages and disadvantages of the set aim and vision.
•Rewarding the employees and supervisors for making the change happen genuinely
Stage 7: Change-Making
The change is a continuous process, so it needs stability and confirmation from time to time, and proclaiming the success at the start of the process is not a good idea. So the change must continue unless and until the success is triumphant. By propelling one new step by utilizing different frameworks is also an incredible approach. To achieve all the achievement set before the beginning of the process, there have to be a continuous searching for advancements. This gives a chance for distinguishing between the right and wrong steps or process and either avoiding or enhancing the set approach
Following are the prerequisites for carrying out this process:
•Examining what went right and wrong in the process
•Setting objectives for keeping the chances high for expanding
•Learning about the possibility of relentless improvement
•managing to create new ideas and form about the advancement
Stage 8: Corporate Culture and Changes
The corporate culture frequently figures out what is accomplished and how much is to go, so keeping track of the necessary process and accomplishments is a necessity. This guarantees the changes that occurred in the department, and it keeps the record of every change occurring in each part of the organization. This helps in giving the impression that change is an active part of the organization and is unstoppable. Additionally, it is essential for the head of the organization to support the change. This also includes the existing staff and the pioneer group of leaders and employees.
Following are the prerequisites for carrying out this process:
•Communicating and recounting the examples of overcoming adversity
•Including the goals and qualities related to the transformation when procuring and training the new staff
•ensuring the capable and qualified staff and excluding the employees who are not helpful with the transformational change
Conclusions
In concluding the paper, the transformational needs of healthcare organization are explored in the department of health insurance which is overpaid due to various factors highlighted in the study mentioned above. These factors and the solutions to overcome the scenario along with the transformational change management process according to Kotter's 8-steps are mentioned. Furthermore, this paper explored the changes needed in the process of overpayment in medical insurance while utilizing Kotter’s 8-Step approach, besides providing the overview of the company, diagnosis and the application of these 8-steps to the transformational needs.
References
Ekin, T., Musal, R. M., & Fulton, L. V. (2015). Overpayment models for medical audits: multiple scenarios. Journal of Applied Statistics, 42(11), 2391-2405.
Green, M. A. (2018). Understanding health insurance: A guide to billing and reimbursement. Cengage Learning.
Hornstein, H. A. (2015). The integration of project management and organizational change management is now a necessity. International Journal of Project Management, 33(2), 291-298.
Musal, R. M., & Ekin, T. (2017). Medical overpayment estimation: A Bayesian approach. Statistical Modelling, 17(3), 196-222.
Pollack, J., & Pollack, R. (2015). Using Kotter's eight-stage process to manage an organizational change program: Presentation and practice. Systemic Practice and Action Research, 28(1), 51-66.
