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Healthcare Revenue Cycle Management Essay solution
When responding to your classmates, compare and contrast your recommended improvements. What would be the best way to introduce your peer’s improvement to the staff? What potential pitfalls do you anticipate?
Studies show that Healthcare Revenue Cycle Management start with patients making appointments to seek medical services and ends when all claims and patient payments have been collected. Today, the life of a patient’s account is not as straightforward as it seems.
In more details, when a patient arranges an appointment, administrative staff must handle the scheduling, insurance eligibility verification, and patient account establishment (Healthcare Revenue Cycle Management, 2020).
One of the top challenges that healthcare organizations face in maintaining stable revenue is collecting payments from patients at or before point-of-service or even after point-of-service. Because of this, healthcare providers are losing money.
Reviewing the processes surrounding the revenue cycle in healthcare organizations, as an Office administrator working in a physician’s office that supports four doctors, one improvement that I would recommend to be implemented in the front-office staff is, Pre-registration accuracy.
This approach allows front-office staff to create a patient account that evaluate medical histories and insurance coverages, making sure that accurate patient information is collected up front and claims are filled free of errors. As an Office administrator, I will create training programs to educate my staffs on the full job functions as a front-office staff.
I will make sure that they understand the revenue cycle from both patient and provider standpoint. Moreover, I will make sure that staffs are well trained to process claims. Preclaims submission activities comprise tasks and functions from the patient registration and case management areas.
Specifically, this portion of the revenue cycle is responsible for collecting the patient’s and responsible parties’ information completely and accurately for determining the appropriate financial class, for educating the patient about his or her ultimate fiscal responsibility for services rendered, for collecting waivers when appropriate, and for verifying data prior to procedures or services being performed and submitted for payment(Casto, 2015).
Reference(s):
Casto, A., & Forrestal, B. (2015). ICD-10-CM code book. Chicago, IL: AHIMA Press.
What Is Healthcare Revenue Cycle Management? (2020). Retrieved from: https://revcycleintelligence.com/features/what-is-healthcare-revenue-cycle-management
Post # 2
Hi Class,
“The Physician revenue cycle has at least 21 critical components that require daily monitoring to keep cash flowing:
” Pre-visit/patient calls for an appointment
” Entering the patient in the EMR
” Check-in
” Visit documentation
” Potential charges recorded on superbill
” Visit coded
” Check out and co-pay collection
” Posting the charge
” Preparing the day’s batch and checking for missing tickets, hospital reports, etc.
” Verification of the charge and information by the billing office
” Scrubbing the bill
” Transmitting the bill electronically or by paper
” Preparing the documentation, if necessary
” Preparing the EOB for the appropriate posting of the payment
” Preparing the check for deposit
” Posting the payment to the correct patient
” Reviewing and preparing any denials
” Getting the additional information for denials from the office
” Resubmitting the claim
” Working the aged accounts receivable
” Sending the patient statements (HSG,2020)”
The office administrator can focus on improving the coding process. Coding is the primary charge capture; it describes the medical service performed (Castro, 2020).
The proper CPT codes will allow the claim to be paid promptly without been denied. “The common mistakes are: entering the wrong CPT codes which are mismatched with the diagnosis, errors in ICD codes, and faults in the patient demographics and patient health information (Wilson, 2020).” Proper billing is a critical part of the revenue cycle.
The coders must have the appropriate training and education to determine the proper code for the medical service. The office administrator can strengthen the process by providing additional training, making sure the most up to date codes are used (making sure the coding software is up to date), and the addition of outside experts to help with the workload.
The goal is to improve insurance claim payments while decreasing delays or denial of claims. The rejection of claims will reduce revenue and increase administration costs to correct claims or appeal the denials. “The insurance companies are looking for any opportunity to deny or delay a claim; it’s not unusual for up to 10 percent of claims to be denied and require rebilling.
That alone can increase a physician’s overhead by $5,600 a year (HSG, 2020).” The office administrator can lower the claims that are denied by improving the coding process, thus improving the revenue of the physician’s office.
Reference
Castro, A.B. (2018) Principles of healthcare reimbursement. American Health Information Management Association. Chicago, IL. ISBN: 978-1-58426-646-4
HSG. (2020). The 21 Components of the Physician Revenue Cycle. Retrieved from https://hsgadvisors.com/articles/the-21-components-of-the-physician-revenue-cycle
Wilson, Jenny. (2020). Three Factors that Affect the Revenue Cycle of Physician Practices. Sybrid+MD. Retrieved from https://sybridmd.com/blogs/value-based-programs/3-factors-that-affect-the-revenue-cycle-of-physician-practices/
Healthcare Revenue Cycle Management Essay solution
RUBRIC Healthcare Revenue Cycle Management Essay |
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Excellent Quality 95-100%
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Introduction
45-41 points The background and significance of the problem and a clear statement of the research purpose is provided. The search history is mentioned. |
Literature Support 91-84 points The background and significance of the problem and a clear statement of the research purpose is provided. The search history is mentioned. |
Methodology 58-53 points Content is well-organized with headings for each slide and bulleted lists to group related material as needed. Use of font, color, graphics, effects, etc. to enhance readability and presentation content is excellent. Length requirements of 10 slides/pages or less is met. |
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Average Score 50-85% |
40-38 points More depth/detail for the background and significance is needed, or the research detail is not clear. No search history information is provided. |
83-76 points Review of relevant theoretical literature is evident, but there is little integration of studies into concepts related to problem. Review is partially focused and organized. Supporting and opposing research are included. Summary of information presented is included. Conclusion may not contain a biblical integration. |
52-49 points Content is somewhat organized, but no structure is apparent. The use of font, color, graphics, effects, etc. is occasionally detracting to the presentation content. Length requirements may not be met. |
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Poor Quality 0-45% |
37-1 points The background and/or significance are missing. No search history information is provided. |
75-1 points Review of relevant theoretical literature is evident, but there is no integration of studies into concepts related to problem. Review is partially focused and organized. Supporting and opposing research are not included in the summary of information presented. Conclusion does not contain a biblical integration. |
48-1 points There is no clear or logical organizational structure. No logical sequence is apparent. The use of font, color, graphics, effects etc. is often detracting to the presentation content. Length requirements may not be met |
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Healthcare Revenue Cycle Management Essay |
Healthcare Revenue Cycle Management Essay