HC$351$DLF$1$A$2024$ Organization and Administration of Healthcare Programs

Initial Posting

For this week's discussion question, you will delve into the intricacies of

revenue management cycles within healthcare systems. You have recently

assumed the role of Vice President of Revenue Cycle Management for

Happy Valley Regional Health System, located in Winston Salem, NC$.$ The

system encompasses an academic medical center, two community

hospitals, and $24$ outpatient primary and specialty clinics. Annually, the

hospitals witness $50,000$ admissions, $75,000$ ER visits, $900,000$ outpatient

encounters, and $1\mathrm{.}3$ million clinic visits. Your directive from the director is

to enhance the revenue cycle process. Several issues have been identified

within the current process:

Failure to get insurance verification or information

Ordering services that are not preauthorized

Not accurately capturing billable services and procedures

Submitting charges after the allowed documentation period

Improper matching entries with charge$-$master file

Documentation and coding errors

Lag times in coding

Failure to follow specific billing rules

Mishandling of insurer payment denials

Posting errors that mis$-$state the remaining outstanding patient balances

You will provide recommendations to improve the process. Make sure that

you provide some discussion on the actual revenue management cycle.

Also include some discussion on how these improvements can save the

organization money and increase its revenue. Provide some discussion on