Revenue Cycle plan
Prepare a revenue cycle plan for a community hospital. Include the following information in your plan:
- Introduction
- Evaluation of clinical data required for payment and reimbursement systems (PPS, DRG, RBRVS, RUGs, VBP, Billing/insurance plans).
- Explanation of chargemaster and claims management applications and processes.
- Assess effect on healthcare finance of revenue management (cost reporting, budget variances).
- Summarize revenue cycle management and reporting processes (CCI, X12N).
- Evaluation of severity of illness and how it impacts the healthcare payment systems.
The format of this plan is like a policy and procedure but is a longer document. Compile your document based on the findings and collection of information for each of the requirements.
Grading Criteria
Assignment 2: Revenue Cycle Plan
Points
Plan includes an evaluation of: Clinical data required for payment and reimbursement systems (PPS, DRG, RBRVS, RUGs, VBP, Billing/insurance plans
15
Plan includes explanation of: Chargemaster and claims management applications and processes.
15
Plan includes assesses: Effect on healthcare finance of revenue management (cost reporting, budget variances).
15
Plan includes summary of: Revenue cycle management and reporting processes (CCI, X12N).
20
Plan includes evaluation of: Severity of illness and how it impacts the healthcare payment systems.
15
Plan is comprehensive and written in a policy and procedure format, based on findings and collection of information
20
Total
100 points
This assignment will assess the following CAHIIM Competencies:
Domain IV. Revenue Cycle
Subdomain IV.A. Revenue Cycle and Reimbursement
- Manage the use of clinical data required by various payment and reimbursement systems
- Take part in selection and development of applications and processes for chargemaster and claims management.
- Apply principles of healthcare finance for revenue management.
- Implement processes for revenue cycle management and reporting.
Domain V. Compliance
Subdomain V.B. Coding
- Identify severity of illness and its impact on healthcare payment systems.