Scenario:

The first step in the healthcare revenue cycle is the scheduling of a service such as an office visit or a surgical procedure. Typically, the patient starts the process by contacting the healthcare provider via phone or a patient portal. If the patient is new to the provider, scheduling includes not only selection of an appointment time, but also the collection of basic demographic information, services required, and insurance coverage status.

Also, keep in mind that when a patient arrives for a service at a hospital or healthcare facility an important step in the patient intake process is to ensure that the patient understands they are responsible for the costs of any services that may not be covered by their insurance. If the patient is a Medicare beneficiary and will receive services that may not be covered by Medicare, then the provider must present an advance beneficiary notification of noncoverage (ABN) to the beneficiary.

At a Valley Critical Access Hospital, individual departments (laboratory, radiology, respiratory therapy, etc.) are responsible for issuing an advance beneficiary notice (ABN) for any tests that Medicare may not cover. Sometimes the Valley Critical Access Hospital will have registration staff issue the ABN. One thing is clear to the HIM Director that there are multiple departments issuing ABNs.

Your initial posting must address ALL four questions.

1. Elaborate on the pros and cons of the practice of individual departments issuing ABNs.
2. Does the HIM Director have a responsibility to change the process? Why or why not?
3. If the HIM Director wants to change the process how would they go about doing that?
4. How does this impact Valley Critical Access Hospital during the front-end process of the revenue cycle? Justify your position.