Answered step by step
Verified Expert Solution
Link Copied!

Question

1 Approved Answer

Background: HealthCare Solutions is a mid - sized healthcare organization providing a range of medical services. Despite having a decent patient volume, the organization faces

Background: HealthCare Solutions is a mid-sized healthcare organization providing a range of medical services. Despite having a decent patient volume, the organization faces significant challenges in managing its revenue cycle effectively. Perceived Problems: The order-entry system, charging system, charge description master, and billing software do not communicate with each other which sometimes prevents accurate information from being shared from one system to another. One situation that keeps reoccurring is that registration clerks update patient demographics and insurance information but this information sometimes makes its way to the billing system and sometimes does not. Also, some of the charges for laboratory tests are not being correctly captured in the billing system. Patients have been calling repeatedly about incorrect bills and are not getting satisfactory explanations about how to read their bills, what the insurance companies are responsible for, and what the patients are responsible for about their financial responsibilities and insurance coverage adequately. This lack of transparency contributes to confusion among patients, leading to delayed or missed payments. Patients often receive bills without clear explanations, causing frustration and disputes. The diagnostic and procedure codes are frequently incorrect on the bills. The Chief Financial Officer does not know why the claims are being rejected by the insurance company. Are the coders doing a poor job or is the documentation not available in the patients medical records? When the claims are denied, they pile up in the Revenue Cycle Managers office and frequently dont get rebilled within the allowed Medicare and insurance timeframes.

Step by Step Solution

There are 3 Steps involved in it

Step: 1

blur-text-image

Get Instant Access to Expert-Tailored Solutions

See step-by-step solutions with expert insights and AI powered tools for academic success

Step: 2

blur-text-image

Step: 3

blur-text-image

Ace Your Homework with AI

Get the answers you need in no time with our AI-driven, step-by-step assistance

Get Started

Recommended Textbook for

Build It For The Real World A Database Workbook

Authors: Wilson, Susan, Hoferek, Mary J.

1st Edition

0073197599, 9780073197593

More Books

Students also viewed these Databases questions

Question

If {Y (t), t 0} is a Martingale, show that E[Y (t)] = E[Y (0)]

Answered: 1 week ago