BHA FPX 4009 Assessment 3 Revenue Cycle Process

Revenue Cycle Process

When a customer schedules an appointment, the healthcare group must be responsive to various tasks known as the income cycle. This includes getting the money back on time. Overcoming this cycle is vital in enhancing and sustaining fiscal status as it is comprised of crude bulky traffic and its ability to do justice to its debts (Kovner & Knickman, 2019). BHA FPX 4009 Assessment 3 McLaughlin and McLaughlin, in their work of 2021, define a good revenue cycle as ensuring that patients pay on time for the services they receive without much exposure to their money. This keeps the business going. The process of the income cycle is illustrated below.

It also determines the mechanisms of many important financial savings in a revenue cycle. The next exercise is patient registration, which gathers data about patient’s demographics and insurance details. Such information is very important in ensuring that a patient is protected and that the said patient can make a claim (Harris & Raskin, 2020). Following this one, which comes after “rendering services,” basically means that medical care is given to the client. In this step, paperwork is highly recommended to determine bills.

Purpose of Each Step

This means that patients have to be registered in the first instance and as a matter of importance regarding the income cycle. Details of the patient’s background, who he is, and policy details are also recorded in this step. It is very relevant to perform the eligibility verification for certain reasons. Ensuring the patient has insurance to be billed and paid is crucial. For instance, a registered worker generates a patient’s record in the healthcare system and alters patient identity and insurance details every time a patient visits or resides at a healthcare facility. This step is critical for checking whether all types of claims are billed and denied frequently (Harris and Raskin, 2020).

BHA FPX 4009 Assessment 3 Billing Implication

The next level is services, which actually offer services where care or services pertaining to the patient’s illness or condition are given to the patient. This is so at this stage because the kind and extent of care provided require good records to justify the next billing implication. For instance, if a doctor undertakes surgery or a medical test, adequate records must be made to ensure the correct amount is paid to the patient or health insurance firm (McLaughlin & McLaughlin, 2021).

Another step is recording services, which captures in detail the services delivered. This is a necessary paper as it will be used in billing and making claims. All functions that are performed to look after a patient are documented in some form or another. This, of course, is very important, particularly in matters of billing and coding. For example, after they have provided any service to a patient, they document the type of service given and any other details in the patient’s EHR for billing purposes, so they prepare their bills (Kovner & Knickman, 2019).

Key Responsibilities of Individuals

The jobs within the overall revenue cycle process assist in managing the healthcare funds, and there are several other connected jobs. As for the efficient handling of the organization’s cash, each of the persons on the list has certain responsibilities and roles to fulfill. BHA FPX 4009 Assessment 3 Patient access representatives are essentially employees in the income cycle team tasked with handling the first phase of the cycle. Some of the top on the list include patient identification, data input, and data verification, where the provider enters and reviews the patient’s information, such as gender, age, and insurance. In this step, before bills and payment, patient identification and insurance information are verified and corrected. For instance, if you walk into a certain health care center, the Patient Access representative receives all the information required and confirms that the patient has stated the right health insurance details. This one has to be sustained to not reject so many claims or postpone the payment of the money owed.

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Medical Coders document themselves with all the particulars of the medical service in a healthcare setting and translate those into coded forms where charges may be made. They are involved in going through the paperwork of healthcare professionals in search of the appropriate ICD-10, CPT, or HCPCS numbers for the services they provide. This means that this coding has to be very accurate in order for you to be able to come up with the right bill for the services and be in line with what the buyers require. For example, when a treatment is done, a Medical Coder assigns the code that best describes the services delivered, hence coming up with claims. As we have seen, coding helps ensure you are paid appropriately and reduces the probability of losing your claim.

BHA FPX 4009 Assessment 3 Billing Specialists

Billing Specialists are responsible for documenting charges, assigning the codes, and submitting the bills to various payers. They are responsible for ensuring that all the charges are documented properly and the documentation corresponds to the payer’s rules on the claims. Concerning their roles, Billing Specialists always consider the claims that have been rejected, analyze why the claims were denied, and from where they resolve the issues, then resubmit the claims again. For instance, BHA FPX 4009 Assessment 3 Billing Specialist transmits an electronic claim made on the basis of the charges provided to them by Medical Coders. In case of an issue with doing a certain job, they contact the concerned persons/organizations to rectify the problem. It enhances the income cycle and payment, which fairly benefits healthcare facilities (Kovner & Knickman, 2019).

Consequences to Institution

Consequently, correctly executing some of the steps in the revenue cycle process may negatively impact the healthcare organization’s capacity to pay for its debts or operate optimally. Firstly, correct registration of the patients is one of the most critical activities when it comes to payment. As a result, errors committed to keeping charge master records, checking, or adding patients’ details will lead to correct billing and insurance rejection by the insurance companies. Here, should a Patient Access Representative careless disregarding the payer’s status with the patient’s insurance, the payer may not honor the claim. This could be bad for the organization because it could lead to late payments – which means that some costs may not get paid again, leading to uncertainty in the organization’s finances (Harris & Raskin, 2020). This means that correct registration is very important if you want to get the money back from the insurance company and avoid being turned down and waiting a long time for repayment.

Convert the PaperWork into Marked

In the next step, the medical coding is also used to convert the paperwork into marked forms that can be used for bills. When code is done wrong, it creates money problems. For instance, some cases aren’t covered, so there is no chance of being reimbursed. If a Medical Coder gives correct numbers for treatment, the claim may be accepted or paid much less than required. This mistake not only revives the payment but also puts the company under audit, which puts its profit and reputation at risk (McLaughlin & McLaughlin, 2021). Some of the measurements presented above indicate that if the code is not done right, the situation could have effects that are as expensive as they are annoying. What is broken is far less relevant than how the claim is fabricated and submitted. If claims are carefully put together and sent to insurance companies, they could avoid problems for the Billing Specialists in the following ways: For instance, when a claim is filled out and submitted for processing. If BHA FPX 4009 Assessment 3 information needs to be included or corrected, it may not be processed and must be resent, which consumes time and extra work. This kind of failure impacts management’s cash flow and increases the cost of doing business, exacerbating economic issues(Kovner & Knickman, 2019). In conclusion, preparing a claim and sending it in is one of the most critical factors in almost any business’s income cycle.

Additional Steps & Challenges

These extra steps and things are considered to be significant for the organization and are aimed at keeping the financial risks controlled so that the organization can be quite sure that it will receive the payment for the services that it provides. The author of the essay also notes that one significant weakness of offering care to the uninsured population is that the individual cannot be given financial advice. Especially for a financial manager, it lies in determining to what extent the patient can pay and depending on whether the patient is capable of paying and which is the reason behind this, the different options of low payment options, a payment scheme, or application for a grant in which the patient can pay the full amount of outstanding balances due. These services assist patients in getting other payment options, such as charity care or certain government options, accepted and ensure that they review how much they will have to pay. For instance, an insurance policy expert might assist an uninsured client to consider options like emergency Medicaid or other corresponding programs in the state. This is a very critical step towards reducing the likelihood of a patient not paying and also informing them an approximate amount they will have to part with (Harris & Raskin, 2020).

Issues that Healthcare Organizations Learn

Whenever people are uninsured, there are always issues that healthcare organizations learn how to address to ensure they get paid in other ways, perhaps after years. When a patient and a service provider have agreed on cost-sharing measures referred to as payment plans, the patient can pay a portion of the service bill while not having to deal with the total price of the service. Besides, BHA FPX 4009 Assessment 3 enhances the probability of being paid by the hulls that do not spend vast sums of money all at once because they are uninsured. For example, a certain doctor, such as the billing expert, can discuss with the patient to allow them to pay the hospital charges in several instances in a week, month, or whichever feels most appropriate to them. All these plans require prior planning and then negotiations that have to be done if both the patient and the health organization are to benefit from them (McLaughlin & McLaughlin, 2021).

Conclusion

In conclusion, I would like to note that the revenue cycle process is significant in the context of how health centers operate because it is a series of steps aligned to ensure that the appropriate billing system for the revenue cycle is determined. The correct payment is received at the right time. All the activities done within any organization, from registering patients to collecting debts, are crucial to determining the performance of the organization and its financial position. Registration of patients, coding, the preparation of claims, and account receivables are all essential activities that assist in avoiding denied claims and lost money and maintaining the ecological niche. Many big personalities perform big roles in the revenue cycle. Some examples are patient access representatives, medical coding specialists, billing specialists, and accounts receivable specialists. The timeliness and efficiency with which they conduct business ensure that mails are dispatched well, claims made, and money collected.

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