Discussion Reply- Response 1-2 paragraphs with 1-2 references
For this discussion, imagine that you are an office administrator in a physician’s office that supports four doctors. Reimbursement from various payers make up the payer mix that can be viewed in the form of an aging schedule. The aging schedule informs management of the dollar amount of revenue that has been generated in the current month and what revenue has yet to be collected from previous months by each payer.While reviewing the processes surrounding the revenue cycle, you have determined that improvements are needed in front office processing. Describe one improvement that you would recommend implementing in the front office staff as it relates to processes with the revenue cycle.
Please reply my following classmates. The main discussion topic is above. When responding to my classmates, compare and contrast your recommended improvements. What would be the best way to introduce your peer’s improvement to the staff? What potential pitfalls do you anticipate?
Alexandria Airo
Hello Everyone!
This week the discussion that we are to complete is about health insurance plans. Health insurance plans are involved with reimbursing healthcare providers. This can have an impact on the revenue cycle. According to Principles of Healthcare Reimbursement, the revenue cycle is the set of responsibilities and actions used to produce revenue in a healthcare organization that include several major components as follows: “pre-claims submission, claims processing, accounts receivable, and claims reconciliation and collection” (Casto, 2018, pg. 233-234). This process is a beginning to end of a patient’s account for payments. Part of this process for the revenue cycle includes maintenance, compliance, and a key member, coding management (Casto, 2018). Therefore, it is important that there maintains a process of the revenue cycle that is not disrupted, is in compliance, and has better methods or actions used within it. A well – functioning revenue cycle is important for the success of any organization.
As an administrator of a physician’s office, reimbursement is viewed in the form of an aging schedule. After observing current procedures, there are improvements needed for the process in the front office. The improvement that can be recommended to implement in the front office staff as it relates to the processes of the revenue cycle would be to make sure that the staff is well-educated and trained on billing and collection of payment, so that they can work more effectively and efficiently. The efficiency of a healthcare organization’s billing processes is crucial and has a critical effect on its financial performance (Advanced MD, 2018). Additionally, in order to get to and maintain a successful billing operation, there is a need for educated and trained staff. When there is an administrative staff that understands and can follow the correct procedures, it can help with ensuring that bills, claims, and any other requests that are required are completed and tendered successfully. Essentially, an educated and trained staff provides a strong revenue cycle.
Specifically, there are a few areas that can contribute to a strong revenue cycle: workflow and use of technology (Advanced MD, 2018). Workflow especially, can positively impact the revenue cycle by having front office staff that can complete the tasks required including verifying and collecting health insurance and co-pays, documentation of visits using correct codes, and using correct activities to submit claims and managing the collections process (Advanced MD, 2018). However, a failure in completing the processes and understanding them can interrupt and change the revenue cycle and lead to a financial upset in the organization (Advanced MD, 2018). Thus, education and training are crucial to avoid financial issues. Part of this improvement on ensuring the staff is educated and trained is also ensuring that there is an organized revenue process. This is achieved by making sure that the administrative staff has looked over requirements and procedures and understands the process. Overall, a well – trained, educated, and experienced team is the most critical driver to positive revenue (Advanced MD, 2018). This can contribute to a more successful and positive financial impact on the healthcare organization.
Hope that you all have a wonderful week!
– Alexandria
References:
Advanced MD. (2018, November 19). Revenue cycle management 101. NueMD.
https://nuemd.com/revenue-cycle-management/rcm-101
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Casto, A. B. (2018). Principles of healthcare reimbursement. MBS Direct Vital Source (6th ed.). American Health Information Management Association AHIMA.
https://mbsdirect.vitalsource.com/#/books/9781584266648/cfi/6/8!/4/2/2/2@0:0
PatriciaSilver
There are many things that can be done to improve the revenue cycle process by the front staff. The front staff will need to always make sure that the patient’s information is correct from the very beginning as well as each time the patient goes in for an appointment. Checking name spelling, insurance information, and other patient demographics is of major importance. Making sure that the proper codes are being used for the type of appointment or admittance that the patient is there for can help to make sure that the payer will pay the bill without any delays (Casto, 2018). Also making sure that the patient’s insurance will cover the procedures or tests before having the patient go perform those will also help (Casto, 2018). The management staff also needs to make sure that the newest software of electric health records (EHR) is being used because that will help the staff with this process. However, the staff will still need to make sure that the codes and information is correct before submitting anything to insurance. Double checking will never hurt anything but will always help to find the mistakes that could cost the hospital or provider office from having a delay from being paid for their services.
Casto, A. (2018). Principles of Healthcare Reimbursement, Sixth Edition. [VitalSource Bookshelf]. Retrieved from
https://bookshelf.vitalsource.com/#/books/9781584266648/