Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages to Order 5-10 Pages
Healthcare Revenue Cycle Management Essay
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).
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
“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
” 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.
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
QUALITY OF RESPONSE NO RESPONSE POOR / UNSATISFACTORY SATISFACTORY GOOD EXCELLENT Content (worth a maximum of 50% of the total points) Zero points: Student failed to submit the final paper. 20 points out of 50: The essay illustrates poor understanding of the relevant material by failing to address or incorrectly addressing the relevant content; failing to identify or inaccurately explaining/defining key concepts/ideas; ignoring or incorrectly explaining key points/claims and the reasoning behind them; and/or incorrectly or inappropriately using terminology; and elements of the response are lacking. 30 points out of 50: The essay illustrates a rudimentary understanding of the relevant material by mentioning but not full explaining the relevant content; identifying some of the key concepts/ideas though failing to fully or accurately explain many of them; using terminology, though sometimes inaccurately or inappropriately; and/or incorporating some key claims/points but failing to explain the reasoning behind them or doing so inaccurately. Elements of the required response may also be lacking. 40 points out of 50: The essay illustrates solid understanding of the relevant material by correctly addressing most of the relevant content; identifying and explaining most of the key concepts/ideas; using correct terminology; explaining the reasoning behind most of the key points/claims; and/or where necessary or useful, substantiating some points with accurate examples. The answer is complete. 50 points: The essay illustrates exemplary understanding of the relevant material by thoroughly and correctly addressing the relevant content; identifying and explaining all of the key concepts/ideas; using correct terminology explaining the reasoning behind key points/claims and substantiating, as necessary/useful, points with several accurate and illuminating examples. No aspects of the required answer are missing. Use of Sources (worth a maximum of 20% of the total points). 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APA 6th Edition is used with only a few minor errors. There are minor errors in reference and/or citations. And/or there is some use of questionable sources. 20 points: Credible scholarly sources are used to give compelling evidence to support claims and are clearly and fairly represented. APA 6th Edition format is used accurately and consistently. The student uses above the maximum required references in the development of the assignment. 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Structure of the Paper (worth 10% of total points) Zero points: Student failed to submit the final paper. 3 points out of 10: Student needs to develop better formatting skills. The paper omits significant structural elements required for and APA 6th edition paper. Formatting of the paper has major flaws. The paper does not conform to APA 6th edition requirements whatsoever. 5 points out of 10: Appearance of final paper demonstrates the student’s limited ability to format the paper. There are significant errors in formatting and/or the total omission of major components of an APA 6th edition paper. They can include the omission of the cover page, abstract, and page numbers. Additionally the page has major formatting issues with spacing or paragraph formation. Font size might not conform to size requirements. The student also significantly writes too large or too short of and paper 7 points out of 10: Research paper presents an above-average use of formatting skills. The paper has slight errors within the paper. This can include small errors or omissions with the cover page, abstract, page number, and headers. There could be also slight formatting issues with the document spacing or the font Additionally the paper might slightly exceed or undershoot the specific number of required written pages for the assignment. 10 points: Student provides a high-caliber, formatted paper. This includes an APA 6th edition cover page, abstract, page number, headers and is double spaced in 12’ Times Roman Font. Additionally, the paper conforms to the specific number of required written pages and neither goes over or under the specified length of the paper.
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