Discussion 3 Responses

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?

Post # 1

Hello everyone,

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/

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