Question
For this week's discussion question, you will explore the revenue management cycle. You have recently been hired as the VP of Revenue Cycle Management for
For this week's discussion question, you will explore the revenue management cycle. You have recently been hired as the VP of Revenue Cycle Management for Happy Valley Regional Health System in Winston Salem, NC. The system is consists of an academic medical center, two community hospitals and 24 outpatient primary and specialty clinics. The hospitals has annually: 50,000 admissions, 75,000 ER visits, 900,000 outpatient encounters, and 1.3 million clinic visits. You have been tasked by the director to improve the revenue cycle process.Some issues that you have identified with the current process:
- Failure to get insurance verification
- Failure to get insurance information
- Ordering services that are not preauthorized
- Performing medically unnecessary services
- Submitting charges after the allowed documentation period
- Improper matching entries with charge-master file
- Documentation and coding errors
- Lag times in coding
- Failure to follow specific billing rules
- Mishandling of insurer payment denials
- Posting errors that mis-state the remaining outstanding patient balances
You will prepare a report for the facility director with your recommendations to improve the process. Make sure that you provide some discussion on the actual revenue management cycle. Also include some discussion on how these improvements can save the organization money and increase its revenue. Provide some discussion on how you will gain employee buy-in with regard to the changes.
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