30 Mar Discussion: Revenue Cycle Components
Discussion: Revenue Cycle Components
In healthcare, the revenue cycle is defined as “all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue” (Oregon Health and Science University, 2018). Processes like charge capture, claim submission, and third-party follow-up are all part of the revenue cycle, and the proper execution of each process leads to a predictable path of revenue. Errors, especially at the beginning of the cycle, can lead to problems that can ripple throughout the process and delay reimbursement or cause additional costs to recover funds.
In this Discussion, you create an infographic to analyze components of the revenue cycle and describe how different departments work together within components.
References:
Oregon Health and Science University. (2018). Revenue cycle. Retrieved from http://www.ohsu.edu/xd/about/services/patient-business-services/revenue-cycle/
To prepare for this Discussion:
• Review this week’s Learning Resources.
• Choose one of the following revenue cycle management components on which to focus for this Discussion:
o Insurance verification
o Prior authorization and precertification
o Financial counseling and patient pay
o Medical necessity
o Case management and utilization management
o Charge description master and charge capture
o Coding and clinical coding improvement
o Claims processing, payment posting, and denial management
o Quality measures for improvement
• Review the assigned chapters from Harrington (2016) and identify and review at least two current, scholarly articles (less than 5 years old) from the Walden library for information on the topic you chose.
• Review the following examples of infographics. Consider their creativity and flow as you are creating your own infographic:
o Pennic, F. (2018). Infographic: Using social determinants of health data to generate value. Retrieved from https://hitconsultant.net/2018/06/08/social-determinants-of-health-2/
o Kansas Hospital Association. (2016). Financial infographic. Retrieved from http://www.kha-net.org/criticalissues/kancareexpansion/financialinfographic/
By Day 4
Post a comprehensive response to the following:
• Create an infographic to describe the component that you chose. You can use Microsoft Word, Microsoft PowerPoint, or a website like Adobe Spark or Canva (both linked in the Learning Resources) to create your infographic. You may also choose to use an app for mobile devices, like Toolbox for Pages or Daily Infographic. Regardless of the software used, when attaching to your Discussion post, save your infographic as a pdf file.
• Respond to the following:
o Identify the revenue cycle management component you chose.
o Expand on which departments need to play roles in accomplishing the task. Specifically, list relevant departments and briefly describe the focus of each department’s role.
o Explain how the task might impact revenue cycle management.
Provide specific examples in your response. Support your post with the Learning Resources and at least two outside scholarly sources.
Resources if you need them:
Harrington, M. K. (2016). Health care finance and the mechanics of insurance and reimbursement. Burlington, MA: Jones & Bartlett Learning.
• Chapter 9, “Coding for the Non-HIM Professional” (pp. 185–206)
• Chapter 10, “Revenue Cycle Management” (pp. 209–224)
• Chapter 11, “Healthcare Fraud and Abuse” (pp. 227–244)
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