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BHA FPX 4009 Assessment 3 The Revenue Cycle Process

BHA FPX 4009 Assessment 3 The Revenue Cycle Process

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BHA FPX 4009 Assessment 3 The Revenue Cycle Process

Student Name

Capella University

BHA-FPX4009 Health Care Reimbursement Systems

Prof. Name

Date

Introduction

The financial stability of healthcare organizations relies on their ability to consistently generate revenue through the services they provide, collectively referred to as the revenue cycle management (RCM). This presentation seeks to acquaint new employees with the various stages of the revenue cycle process and their individual responsibilities within it.

Outline

The presentation will delve into the following subjects:

  • The revenue cycle process.
  • Individual roles within the cycle.
  • The significance of the process for healthcare organizations.
  • Potential challenges encountered in their roles.

Revenue Cycle Management (RCM)

Critical phases in the revenue cycle process include:

  1. Patient registration.
  2. Gathering demographics and payor information.
  3. Service delivery.
  4. Documentation of services.
  5. Charge establishment.
  6. Claim or bill preparation.
  7. Claim submission.
  8. Payment reception.
  9. Accounts receivable management.

Purpose of Each Step

  • Pre-claims submission activities: Comprising patient registration and case management, focusing on accurate patient information gathering and financial education.
  • Claims processing activities: Encompassing charge capture, order entry, coding, auditing, and claims submission.
  • Accounts Receivable: Involving managing patient or third-party payer debts.
  • Claims reconciliation and collections: Including comparing expected reimbursement to actual reimbursement and managing outstanding payments.

Purpose of Revenue Cycle Management

The objective of RCM is to improve the efficiency and effectiveness of the revenue cycle process, which may include enhancing accounts receivable, communication, and developing educational materials.

Key Responsibilities of Individuals

Key duties include accurate data collection during registration, patient financial education, demographic data collection during admission, reporting service charges, and compliance with coding and billing regulations.

Consequences To Organization

Failure to report charges may result in reimbursement losses, and delayed payments reduce the likelihood of reimbursement. Inaccurate pre-claims information can also lead to reimbursement loss.

BHA FPX 4009 Assessment 3 The Revenue Cycle Process

Additional Steps & Challenges

Options for uninsured patients include self-pay, financial aid, private health insurance, or government funding. It’s crucial to promptly rectify human errors, comply with coding and billing regulations, and align RCM protocols with compliance plans.

Conclusion

Understanding the revenue cycle process and its associated challenges is crucial. Each member’s contribution is essential for efficient and compliant reimbursement processes, highlighting the significance of teamwork and proactive approaches.

References

Casto, A. (2018). Principles of Healthcare Reimbursement (6th ed.). American Health Information Management Association (AHIMA).

Farmer, L. (2014). The 7 Deadly Sins of Public Finance. Governing.

BHA FPX 4009 Assessment 3 The Revenue Cycle Process

Vega, K. B. (2013). Successfully Negotiating Managed Care Contracts. Healthcare Financial Management Association.




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