The Revenue Cycle Process and REIMBURSEMENT MODELS

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Develop a 10-slide PowerPoint presentation with accompanying 10 to 20 minutes of audio targeted at educating new hires at a health care organization about the revenue-cycle process.

INTRODUCTION

The financial health of the health care organization depends upon its ability to generate consistent and recurring funds from the services it provides. Collectively referred to as the revenue cycle (RCM), critical stages in this process include:

  • Patient registration.
  • Collection of demographics and payor source.
  • Rendering services.
  • Documenting services.
  • Establishing charges.
  • Preparing the claim or bill.
  • Submitting the claim.
  • Receiving payment.
  • Managing accounts receivable.

Decreasing payment delays and lost revenues is a point of interest for many health care managers tasked with oversight of the RCM process. Innovative approaches in technology have assisted with streamlining the RCM process and allowed for automation of many processes, resulting in expedited processing and quick remittance.Managed care dollars represent a significant portion of all health care organizations’ reimbursements. As a result, health care organizations seek to establish contracts with large managed care organizations (MCOs). Negotiating and securing contracts with MCOs is important for several reasons, including preserving revenues, enhancing patient satisfaction, and generating additional sources of revenue.All contracts will contain language outlining the administration of the contract along with the payment schedule. While the payment schedule may be seen as the most important element, the terms outlined within the contract are equally as vital to the financial success of the organization.This assessment focuses on the revenue cycle and how technological innovations have impacted reimbursement for health care organizations. You will take on the role of a patient access supervisor. One of your job functions entails educating new hires on the revenue cycle process.

DEMONSTRATION OF PROFICIENCY

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

  • Competency 3: Explain the organizational revenue cycle process.
    • Identify key steps of the revenue cycle process.
    • Explain the purpose of each identified step in the revenue cycle process.
    • Describe key components of each function in the revenue cycle process.
    • Explain the consequences of failing to conduct the function identified.
    • Explain additional steps and challenges in the revenue cycle process when working with an uninsured patient.
  • Competency 4: Communicate in a manner that is scholarly, professional, and respectful of the diversity, dignity, and integrity of others and is consistent with health care professionals.
    • Demonstrate effective communication through writing and proper use of APA style with no significant errors, and supports analysis and recommendations with appropriate current literature.