Monitoring the Revenue Cycle

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Alfred State Medical Center's charges, payments, and adjustments from third-party payers for the month of July are represented in the table below. As part of your responsibility as a member of the Revenue Cycle Performance Committee, you are required to monitor various component of the revenue cycle and report your findings to the committee. The committee uses your report to determine new and continued contracts with specific payer types.
In preparation for your report you must calculate and analyze the data.

    1. Calculate the percentage of charges, payments, and adjustments for each third-party payer and enter the percentages in the percentages columns of the table.

Payer

Charges

Payments

Adjustment

Charges

Payments

Adjustments

BC/BS

$450,000

$360,000

$90,000

 

 

 

Commercial

$250,000

$200,000

$50,000

 

 

 

Medicaid

$350,000

$75,000

$275,000

 

 

 

Medicare

$750,000

$495,000

$255,000

 

 

 

TRICARE

$150,000

$50,000

$100,000

 

 

 

Totals

$1,950,000

$1,180,000

$770,000

100%

100%

100%

 

  1. Based on the percentages calculated in the charges column, identify the payer the facility does the most business with and the payer it does the least business with.
  2. Based on the percentages calculated in the payment column, identify the payers that reimburse the facility the most and the least.
  3. Based on the percentages calculated in the adjustments column, identify the payers that proportionately reimburse the facility the most and the least.
  4. Prepare a report of your findings and recommendations regarding specific payers to present at the next Revenue Cycle Performance Committee.

 

 

Example of how to complete

 

IF you're having problems with Module 11 Assignment, I hope this helps.

 

 

Payer

Charges

Payments

Adjustment

Charges

Payments

Adjustments

 

BC/BS

$450,000

$360,000

$90,000

 23%

 

 

Totals

$1,950,000

$1,180,000

$770,000

100%

100%

100%

          

 What you’re doing is calculating the percentage of eachpayer charges, payments and adjustments.

$450,000 / $1,950,000 = 0.2307 x 100 = 23%

$360,000 / $1,180,000 = xxx  x 100 = xxx %

$90,000 / $770,000 = xxx x 100 = xxx %

Repeat these steps for each payer. Then complete the work for questions b, c and d.

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