In Module One, our first step is to direct our focus on what healthcare reimbursement means and how that meaning will be applied throughout the course. In Module One, you will be provided with explanations of the terminology and methodologies surrounding the cost of healthcare services and, subsequently, how providers of those services are compensated. Reimbursement in a healthcare context refers to the payment that providers and facilities receive for the services that they provide their patients. Providers and facilities include physicians, hospitals, clinics, outpatient rehabilitation centers, home healthcare centers, and other healthcare facilities. Many providers are not-for-profit as opposed to investor-owned. Questions that will be answered in this module include: · What are reimbursement methodologies and how do they impact healthcare organizations? · What are the current trends in healthcare reimbursement? · How might healthcare administrators differentiate between reimbursement methods? · How are financial management principles applied to reimbursement methods? · Who are the key stakeholders surrounding healthcare reimbursement? The answers to these questions will provide you with a better understanding of the background, context, and trends surrounding healthcare reimbursement systems. Further, you will find it helpful to assume the role of a healthcare administrator as you practice what it would be like to assume a management position. Although you will have your own personal opinions based on experiences from a patient perspective, for this course, you will view the assignments through the lens of the healthcare administrator. The administrator is challenged with providing the best care and services to the communities that they serve, while charging a price that is affordable to both the patient and the organization. The administrator must also take into account the various compliance standards and government regulations. Why Study Reimbursement? Healthcare administrators and other health personnel can better meet the needs of their patients, clients, and organization by offering clear guidelines and cost structures concerning healthcare reimbursement. The key stakeholders of healthcare reimbursement systems are patients, healthcare providers, and third-party processors. As such, there are many perspectives to consider when administrators develop strategic plans designed around revenue generation. Many healthcare administrators are involved in contract management decisions and also represent their organizations by negotiating with managed care organizations and third-party payers. The Affordable Care Act is one of the largest pieces of healthcare legislation in our era. The law itself is over 1,000 pages covering funding, Health Insurance Portability and Accountability Act (HIPAA) requirements, insurance coverage, health information systems, and reimbursement. Not surprisingly, this has contributed to the increase in employm ...

1. In Module One, our first step is to direct our focus on what
healthcare reimbursement means and how that meaning will be
applied throughout the course. In Module One, you will be
provided with explanations of the terminology and
methodologies surrounding the cost of healthcare services and,
subsequently, how providers of those services are compensated.
Reimbursement in a healthcare context refers to the payment
that providers and facilities receive for the services that they
provide their patients. Providers and facilities include
physicians, hospitals, clinics, outpatient rehabilitation centers,
home healthcare centers, and other healthcare facilities. Many
providers are not-for-profit as opposed to investor-owned.
Questions that will be answered in this module include:
· What are reimbursement methodologies and how do they
impact healthcare organizations?
· What are the current trends in healthcare reimbursement?
· How might healthcare administrators differentiate between
reimbursement methods?
· How are financial management principles applied to
reimbursement methods?
· Who are the key stakeholders surrounding healthcare
reimbursement?
The answers to these questions will provide you with a better
understanding of the background, context, and trends
surrounding healthcare reimbursement systems. Further, you
will find it helpful to assume the role of a healthcare
administrator as you practice what it would be like to assume a
management position. Although you will have your own
personal opinions based on experiences from a patient
perspective, for this course, you will view the assignments
through the lens of the healthcare administrator. The

2. administrator is challenged with providing the best care and
services to the communities that they serve, while charging a
price that is affordable to both the patient and the organization.
The administrator must also take into account the various
compliance standards and government regulations.
Why Study Reimbursement?
Healthcare administrators and other health personnel can better
meet the needs of their patients, clients, and organization by
offering clear guidelines and cost structures concerning
healthcare reimbursement. The key stakeholders of healthcare
reimbursement systems are patients, healthcare providers, and
third-party processors. As such, there are many perspectives to
consider when administrators develop strategic plans designed
around revenue generation. Many healthcare administrators are
involved in contract management decisions and also represent
their organizations by negotiating with managed care
organizations and third-party payers.
The Affordable Care Act is one of the largest pieces of
healthcare legislation in our era. The law itself is over 1,000
pages covering funding, Health Insurance Portability and
Accountability Act (HIPAA) requirements, insurance coverage,
health information systems, and reimbursement. Not
surprisingly, this has contributed to the increase in employment
in the healthcare industry. Employment in healthcare-related
jobs is expected to rise by 22% over the next 7 to 10 years
(Bureau of Labor Statistics, 2014). Hospitals account for
approximately 39% of total healthcare employment (Bureau of
Labor Statistics, 2014).
Not surprisingly, there are career opportunities for those
individuals entering the healthcare administration field. The
study of reimbursement systems and methodologies provide
students with knowledge needed to make management decisions
impacting the revenue cycle. Consequently, management
decisions impact the sustainability of the healthcare

3. organization.
Financial Management and the Role of the Healthcare
Administrator
Financial management rests on theory, concepts, and tools that
help managers make informed decisions. Therefore, in the
context of reimbursement, healthcare administrators find
themselves applying financial management principles to revenue
cycle management. Healthcare information systems provide
resource data that informs decision making (Stansfield, Walsh,
Prata, & Evans, 2006). One source of financial data can be
found in the general ledger system. Another source of data can
be found in admission reports. Specific reports can provide
information on the number of encounters (the number of
patients that a doctor has seen). One example of an external
report is a report on the number of aging individuals located in
a geographical location. This information can be found on a
state or government website (Centers for Medicare & Medicaid
Services, 2015). Healthcare administrators use many sources of
internal and external data to inform strategic, operational, and
financial decision making.
Next Steps
In Module Two, you will examine healthcare reimbursement
based on the reporting guidelines established by the Centers for
Medicare & Medicaid Services (CMS). You will visit the CMS
Website frequently in this course because of the vast amount of
information that is provided on reimbursement, clinical coding,
and other Medicare- and Medicaid-related topics.
References:
Bureau of Labor Statistics. (2014). Occupational outlook
handbook. Retrieved from http://www.bis.gov/ooh/community-
and-social-service/social-and-human-service-assistants.htm
Centers for Medicare & Medicaid Services. (2015). Medicare.
Retrieved from https://www.cms.gov/Medicare/Medicare.html

4. Stansfield, S. K., Walsh, J., Prata, N., & Evans, T. (2006).
Information to improve decision making for health. In D. T.
Jamison, J. G. Breman, A. R. Measham, G. Alleyne, M.
Claeson, . . . P. Musgrove (Eds.), Disease control priorities in
developing countries (pp. 1017–1030) (2nd ed.). Washington,
DC: World Bank. Retrieved from
http://www.ncbi.nlm.nih.gov/books/NBK11731
Harrisburg University
ISEM 547
Vendor Management
Objectives
Vendor Management Overview
Vendor Manager/VRM
Vendor Management Best Practices
Vendor Management Selection
Vendor Managaement Framework
2
Vendor Management
Overview

5. 3
What is Vendor Management?
Vendor Management is a term used to describe the process of
finding, qualifying and doing business with vendors. Common
activities include researching vendors, negotiating contracts,
obtaining quotes, evaluating performance, driving innovation
and service excellence, creating and updating vendor files, and
ensuring contract compliance (internal and external), work
order, invoicing/billing, and payment approvals.
4
What does a Vendor Manager/VRM do?

6. Vendor Manager: (also referred to as vendor relationship
managers) handle relationships with vendors and their
company’s operational department.
Organizations provide them with the authority and mechanisms
to engage, govern, manage the relationship, optimize and to
negotiate on behalf of their company for the best value of
purchases that support its operations and business objectives.
5
What does a Vendor Manager/VRM do?

7. Manage the Relationship
Contract Management
Engagement Management
Governance Oversight
Multivendor Integrations
Problem Management
Driving Mutual Value
Document Management
6
Vendor Management
Success Tips & Best Practices
7
Vendor Management - Tips

8. Share Information and Priorities (Need to know basis)
Balance Commitment and Competition
Allow key vendors to help you strategize
Build Long-Term Relationships
Seek to Understand Your Vendor’s Business Too
Negotiate a Win-Win Agreement
Come Together on Value
8
Vendor Management – Best Practices
Vendor Selection
Scrutinize the Prospects
Remain Flexible
Monitor Performance

9. Communicate
IT Management Framework
9
Vendor Management
Vendor Management Selection Process
10
Vendor Management – Selection Process
Analyze Business Requirements

10. Vendor Search - Request for Information (RFI)
Request for Proposal (RFP)
Proposal Evaluation & Vendor Selection
Contract Negotiation Strategies
11
Vendor Management – Selection Process
Assemble an Evaluation Team
Evaluation Team – Define Needs & Requirements
Define the Product, Material or Service
Define the Technical and Business Requirements
Define the Vendor Requirements
Publish a Requirements Document for Approval
12
Vendor Management – Selection Process
Evaluation Team – Vendor Search
Compile a List of Possible Vendors
Select Vendors to Request More Information From
Write a Request for Information (RFI)
Evaluate Responses and Create a "Short List" of Vendors
13

11. Vendor Management – Selection Process
Select Evaluation Team Members & SMEs – Create Request for
Proposal (RFP)
Submission Details
Introduction and Executive Summary
Business Overview and Background
Detailed Specifications
Assumptions and Constraints
Terms and Conditions
Financial & Pricing (Separate from Technical Submission)
Selection Criteria
14
Vendor Management – Selection Process
Evaluation Team (Advisors & Voting Members) – Vendor
Evaluation & Selection
Preliminary Review of All Vendor Proposals
Record Business Requirements and Vendor Requirements
Assign Importance Value for Each Requirement
Assign a Performance Value for Each Requirement
Calculate a Total Performance Score
Select the Winning Vendor
15

12. Vendor Management – Selection Process
Specific Evaluation Team (Negotiators & Advisors) – Vendor
Negotiations
List Rank Your Priorities along with alternatives
Know the Difference Between What You Need and What You
Want
Know Your Bottom Line So You Know When to Walk Away
Define Any Time Constraints and Benchmarks
Assess Potential Liabilities and Risks
Confidentiality, non-compete, dispute resolution, changes in
requirements
Do the Same for Your Vendor (i.e. Walk a Mile in Their Shoes)
Best and Final Offer (BAFO)
16
Vendor Management – Selection Process
Other Considerations
Legal Counsel
Financial Viability Assessment & Financial Expert
Logistics
Authority to Negotiate
17

13. Vendor Management
Establishing a Vendor Management Framework
18
Vendor Management Framework
19
Vendor Management Program (Mission & Objective)
Leverage Best Practices
Optimize External Spend
Drive Innovation
Rationalize Vendors
Manage contract performance, relationship, and demand
Improve Vendor Relationships
Reduce Risk
20

14. Vendor Management Program (Org & Staffing)
Determine the best organizational structure
Determine the Staffing Requirements and Compliment
Define the roles, duties & responsibilities
Skill-sets & Competencies
21
Vendor Management Program (Value Metrics)
Efficiencies
Performance
Relationship Quality
22
Vendor Management Program (Optimize Vendor Portfolio)
Strategic Vendors
Legacy Vendors
Emerging Vendors
Tactical Vendors
23

15. Vendor Management Program (Create Strategic Management
Program)
Develop a formal IT vendor management program, defining the
organization, governance, and processes, and procedures
necessary to effectively manage a multivendor environment in a
comprehensive manner.
Strategic vendor management is a discipline of managing those
vendors that are most critical to the business and is intended to
replace transaction driven or ad-hoc approach to vendor
management.
24
Vendor Management Framework (Vendor Acquisition &
Divestiture)
Evaluate Selected Vendors
Negotiate Contracts
Onboard Vendors
Manage Transitions
Vendor Dispositions
25
Vendor Management Framework (Managing Vendors)
Manage Contracts & Finances
Manage Performance
Manage Relationships

16. Align Demand & Capacity Management
Manage Vendor Risk
26
Vendor Management Framework (Establish & Articulate Value)
Manage Communications Plan
Establish Vendor Operating Model
Define & Manage Continuous Improvement
Drive Innovation
Develop Dashboards & Analytics
27
Vendor Governance
Vendor Governance: vendor governance assigns the rights and
responsibilities for all the decisions regarding the use and
management of vendors, with the objective of managing the
organization’s risks and achieving desired business outcomes.
Vendor governance is a subset of corporate and IT governance
frameworks.
28

17. Assignments
Chapters 5, 6, 10 (IT Managers Handbook)
Homework 6: Cloud & Vendor Management
29
Harrisburg University
ISEM 547
Cloud Services Management
Objectives
Cloud Computing Overview
Cloud Computing Characteristics
Cloud Computing Models
Cloud Computing Deployment Models
Demarks of Ownership
Cloud Computing Opportunities
Cloud Computing Controls & Accountability
Outsourcing Considerations with Cloud Computing
2

18. Cloud Computing Models
Definitions, Structures, and Pros & Cons
3
What is Cloud Computing?
Cloud computing, also on-demand computing, is a kind of
Internet-based computing that provides shared processing

19. resources and data to computers and other devices on demand.
The cloud computing model is composed of five essential
characteristics, three service models, and four deployment
models
4
Cloud Computing Models Characteristics
The cloud computing model essential characteristics
On-demand self-service
Broad Network Access
Resource Pooling
Rapid Elasticity
Measured Service
5
Cloud Computing Models
Software as a Service (SaaS)
Platform as a Service (PaaS)
Infrastructure as a Service (IaaS)
6

20. Cloud Computing Deployment Models
Private Cloud
Community Cloud
Public Cloud
Hybrid
7
Cloud Computing Models - Ownership
8
Cloud Computing Models - Opportunities
Staff Specialization
Platform Strength
Resource Availability
Backup & Recovery
Mobile Endpoints

21. Data Concentration
9
Cloud Computing Models - Accountability
Loss of Control
Service Agreements
Security & Privacy
Governance
Compliance
Laws & Regulations
Data Location
10
Cloud Computing Models - Accountability
Electronic Discovery
Trust
Data Ownership
Composite Service
Visibility
Ancillary Data
Risk Management
11

22. Cloud Computing Models - Accountability
Architecture
Virtual Machine Environments
Virtual Network Protection
Client Side Protection
Identity & Access Management
Data Protection & Availability
Data Sanitization
12
Cloud Computing Models - Accountability
Availability - Outages
Incident Response
Incident Analysis & Resolution
13
Cloud Computing Models – Preliminary Activities
Preliminary Activities when considering the use of cloud
services

23. Specify Requirements
Exit Strategy
Compliance
Service Agreement
Security & Privacy Risk Assessments
Underlying Technology
14
Cloud Computing Models – Preliminary Activities
Cloud Provider Viability & Competency
Experience and technical expertise of personnel
The vetting process personnel undergo
Quality and frequency of security and privacy awareness
training provided to personnel
Account management practices and accountability
The type and effectiveness of the security services provided and
underlying mechanisms used
The adoption rate of new technologies
Change management procedures and processes
The cloud provider’s track record
The ability of the cloud provider to meet the organization’s
security and privacy policy, procedures, and regulatory
compliance needs
Position and financial strength in the industry
15

24. Cloud Computing Models – Preliminary Activities
Cloud Provider Contractual Obligations
A detailed description of the service environment, including
facility locations and applicable security requirements
Policies, procedures, and standards, including vetting and
management of staff
Predefined service levels and associated costs
The process for assessing the cloud provider’s compliance with
the service level agreement, including independent audits and
testing
Specific remedies for harm caused or noncompliance by the
cloud provider
The period of performance and due dates for any deliverable
The cloud provider’s points of interface with the organization
The organization’s responsibilities for providing relevant
information and resources to the cloud provider
Procedures, protections, and restrictions for collocating or
commingling organizational data and for handling sensitive data
The cloud provider’s obligations upon contract termination,
such as the return and expunging of organizational data
16
Cloud Computing Models – Preliminary Activities
Additional areas where the terms of the service agreement
should have extreme clarity to avoid potential problems.
Ownership rights over data
Locus of organizational data within the cloud environment
Security and privacy performance visibility

25. Service availability and contingency options
Data backup and recovery
Incident response coordination and information sharing
Disaster recovery.
17
Cloud Computing Models – Preliminary Activities
An effective operational continuous monitoring program as one
that includes:
Configuration management and control processes for
information systems;
Security impact analyses on proposed or actual changes to
information systems and environments of operation;
Assessment of selected security controls (including system-
specific, hybrid, and common controls) based on the defined
continuous monitoring strategy;
Security status reporting to appropriate officials; and
Active involvement by authorizing officials in the ongoing
management of information system-related security risks.
18
Readings & Assignments
Chapters 5, 6, 8, 10 (IT Managers Handbook)
19