The Outpatient Revenue Cycle

The outpatient revenue cycle starts with a patient encounter at a provider's office location or for outpatient services at a hospital facility. It ends when the provider or hospital is paid for the services provided. Each encounter is a separate cycle.

The basic steps of the outpatient revenue cycle mirror the inpatient cycle as they both include preregistration, registration, charge capture, claim submission, remittance processing, insurance follow-up, and patient collections.

You will create a slide presentation with ten slides plus a title and reference slide (12 total) that describes the steps in the outpatient revenue cycle for the case below. In this presentation, you will describe the outpatient revenue cycle by showing how a patient encounter is processed.

Here is the scenario:

A patient named Teddy Bear, age 65, was diagnosed with colorectal cancer eight years ago and had a bowel resection and ileocolic anastomosis. His PCP ordered a CEA test. Today, he went to the outpatient lab facility of the hospital and had blood drawn for the test. His insurance is original (traditional) Medicare, and he has a Medigap plan. All yearly deductibles have been met and he has no copayment. Include case background and explain the case using the following terms. Highlight each term in the presentation.

Claim type

Coinsurance

Contractual agreement

Coordination of benefits (COB)

Copayment

Deductible

Demographic data

Episode-of-care (EOC)

Explanation of benefits (EOB)

Medical necessity

Reimbursement

Remittance advice (RA)

Third-party payer(s)

*Reference(s) required (APA Format), Correct spelling, and grammar.

References should be from a .org, .gov, or .edu domain. Proofreading for grammar and punctuation is required. The document is to contain original wording.