Data collection is an important aspect of the revenue cycle functions. Collection begins with the recording of patient demographic and insurance information at the point of registration. It then continues throughout the revenue cycle workflow with the capture of treatment information, charges, diagnostic and procedural codes, claims data, and information resulting from payments and denials. The data is housed in various databases, some that are standalone and others that are integrated. These databases can be accessed by authorized personnel to obtain the data needed in the performance of the healthcare facility's planning, operations, and reporting requirements.

You work as a Coding Manager at a hospital. The hospital is considering building an Ambulatory Surgery facility for orthopedic and general surgery procedures, and several providers are interested in moving their practices and surgical interventions to this new location. In preparation for the Request for Proposal (RFP), the executive team is in need of clinical data. The HIM Director has been contacted and asked to pull statistical data.

At the HIM Director's request, you have created a report of the top 5 diagnoses/procedures that shows total charges, total reimbursement, and quarterly patient volumes. In addition to the report, the HIM Director would like for you to analyze the data.

To complete this assignment, firstdownload a copy of the report. Then, in a separate Word document, type your responses to the questions below:

1. Which of the diagnoses/procedures would be the highest revenue generating?
2. Which of the diagnoses/procedures may be considered for exclusion from the initiative based on volumes or revenue-and why?
3. Which of the diagnoses/procedures has a high volume, but lowest revenue?
4. Which of the diagnoses/procedures would benefit the most with a shift inpayer mix(increase or decrease in patient volumes by payer)? Which payer and what type of change in volumes? Note:Payer mixis the proportion of reimbursement that is generated from the different payers within a subset. In this example, there are 3 payers contributing to the total reimbursement for the 5 different subsets of procedures performed.
5. Which of the diagnoses/procedures would benefit the most from increased patient volumes?

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Submit your completed assignment by following the directions linked below. Please check theCourse Calendarfor specific due dates.

Save your assignment as a Microsoft Word document. (Mac users, please remember to append the ".docx" extension to the filename.) The name of the file should be your first initial and last name, followed by an underscore and the name of the assignment, and an underscore and the date. An example is shown below:

Jstudent_exampleproblem_101504

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Statistical Report for Module 02 Written Assignment Payers: MED = Medicare, COMM-Commercial, MA-Medicaid (Medical Assistance) Principal Diagnosis & Procedure G56.0 Carpal Tunnel (Carpal Tunnel Repair) S42.30 Fracture, Humerus (Closed reduction with pinning) J35.01 Chronic tonsillitis (T&A) Vol (Qtrly) Ttl Charges Ttl Reimbursement Ttl Revenue Payer Vol & Reimbursement MED Payer Vol & Reimbursement COMM Payer Vol & Reimbursement MA 20 $101540 $ 102540 $1000 8 pts $42016 Aver per pt $5252 3 pts $14381 Aver per pt $4794 15 Average per patient $5077 $201444 9 pts $46143 Aver per pt $5127 $211677 $10233 5 pts $70559 8 pts $120894 2 pts $20224 Aver per pt $14112 Aver per pt $15112 Aver per pt $10112 D12.5 Sigmoid Colon Polyp (Colonoscop y with Polypectomy ) N93.8 Uterine Bleeding (D&C) 37 Average per patient $13430 42 18 $105380 Average per patient $2509 $102651 Average per patient $2774 $ 88001 (-$17379) 1 pts $1714 Aver per pt $1714 30 pts $77270 Aver per pt $2576 11 pts $9017 Aver per pt $820 $ 105115 $ 2464 17 pts $46916 Aver per pt $2760 19 pts $56144 Aver per pt $2955 1 pts $2055 Aver per pt $2055 $ 99552 Average per patient $ 97324 (-$2228) 7 pts $35000 Aver per pt $5000 9 pts $59950 Aver per pt $6661 2 pts $2374 Aver per pt $1187 $5531