Review the entire depth and breadth of the revenue cycle in figure 5.1. Are there any elements
Question:
Review the entire depth and breadth of the revenue cycle in figure 5.1. Are there any elements that appear unnecessary or extraneous? Which elements take the most time for the organization? Which take the least? Why?
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Before Patient Contact Patient Contact Establish objectives Establish performance standards and measures Determine and establish inpatient and outpatient revenue cycle policies and procedures Determine HIPAA requirements Preregistration Ensure that the patients personal, demographic, and insurance information is collected on an accurate and timely basis Collect information prior to service being performed Generally by telephone Billing and Collection Bill Preparation and Transmission System throughout audits Manual production Electronic production and transmission Contract management systems Coordinate revenue cycle-friendly managed care contracting Precertification and Insurance Verification Contact insurance company Certify and verify patient's information and coverage Insurance card issues Electronic preauthorization Denials Management Billing audits Fraud and abuse issues Legal and compliance issues Internal controls Patient Services Registration Complete paperwork Centralized versus decentralized areas Obtain critical signatures Financial counselling Follow-up Third party: Medicare Medicaid Managed care Payment compliance . Self pay: Deductible: Coinsurance Charity care Patient Discharge Charge Capture Timely and accurate charge generation Chargemaster issues HIS review Cash Collections and Posting Bad debts expense Charity care Financing .Collection agency selections .Collection agency performance monitoring Cash posting Coding and Reimbursement Revenue maximization activities Documentation capture and review DRG coding APC coding Managed care Timeliness Performance Monitoring Set the goals Create plans to achieve goals Implement the plans Monitor the results of the implementation Feed the results back to the affected parties Figure 5.1. The Hospital Revenue Cycle
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Related Book For
Fundamentals Of Health Care Financial Management
ISBN: 9781118801680
4th Edition
Authors: Steven Berger
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