BHA FPX 4009 Assessment 3 The Revenue Cycle Process BHA-FPX4009 Health Care Reimbursement Systems

 

Outline

The presentation will cover the following topics:

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

Revenue Cycle (RCM)

Critical stages in the revenue cycle process include:

1. Patient registration.
2. Collection of demographics and payor source.
3. Rendering services.
4. Documenting services.
5. Establishing charges.
6. Preparing the claim or bill.
7. Submitting the claim.
8. Receiving payment.
9. Managing accounts receivable.

Purpose of Each Step

1. Pre-claims submission activities: Comprise tasks from patient registration and case management, focusing on gathering accurate patient information and educating them on financial responsibilities.
2. Claims processing activities: Encompass charge capture, order entry, coding, auditing, and claims submission.
3. Accounts Receivable: Involves managing amounts owed by patients or third-party payers.
4. Claims reconciliation and collections: Includes comparing expected reimbursement to actual reimbursement and managing outstanding payments.

Purpose of Revenue Cycle Management

The aim of RCM is to enhance the efficiency and effectiveness of the revenue cycle process. Sample objectives may include improving accounts receivable, communication, and developing educational materials.

Key Responsibilities of Individuals

Key responsibilities include accurate data collection during registration, educating patients on financial obligations, collecting demographic data during admission, reporting service charges, and ensuring compliance with coding and billing.

BHA FPX 4009 Assessment 3 The Revenue Cycle Process

Consequences To Organization

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

Additional Steps & Challenges

Options for uninsured patients include self-pay, financial assistance, private health insurance, or government financing. It’s crucial to rectify human errors promptly, stay compliant 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 vital for efficient and compliant reimbursement processes, emphasizing the importance 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.