Assessment 5

Overview

In this module, you learned about the significance of staffing in healthcare strategic planning ini"a"ves and the revenue cycle.

You also looked at the role of leadership to improve team performance and the areas in the back-end revenue cycle.

To recap, the components in the back-end revenue cycle include (but are not limited to) the following areas:

Claims Produc"on

Claims Submission

Determining Expected Reimbursement

Adjudica"on

Benefits Statements

Claims Reconcilia"on

Denial Management

In this assignment, you will create an analysis report on the staffing system of a healthcare organiza"on based on the

iden"fied areas of the back-end process of the revenue cycle.

This assignment will help you describe best prac"ces for revenue-cycle staffing models and align staffing models with

strategic planning ini"a"ves. It will also enable you to demonstrate how key leadership competencies improve revenue-cycle

team performance. From a healthcare management perspec"ve, this ac"vity will help you understand how to set up and

manage a robust staffing process. This ac"vity will help you prepare for subsec"ons 2C (Staffing Impact) and 4B (Workflow

Assessment Findings) in the course project.

Direc!ons

Create an analysis report on the staffing requirements in the backend process of a healthcare organiza"on.

If you need wri"ng support, access the Online Wri"ng Center through the Academic Support module of your course.

Specifically, you must address the following rubric criteria:

1. Staffing Competencies: Describe the staffing competencies needed for hiring team members in the back-end revenue

cycle. Consider the following ques"ons to guide your response:

What competencies are needed for each area of the revenue cycle?

What makes this competency specific to the healthcare domain?

2. Revenue Integrity: Explain the importance of each area of the revenue cycle for preserving revenue integrity.

Consider the following ques"ons to guide your response:

How does each area incorporate opera"onal efficiency?

How is compliance adherence built into each area?

3. Role of Leadership: Explain the role of leadership in ensuring staffing competencies. Consider the following ques"ons

to guide your response:

What skillsets or knowledge should a leader look for when recrui"ng somebody for the back-end process?

How would the leader keep the team updated in skillsets and knowledge?

4. Lapses and Preven!on: Iden"fy processes to prevent lapses and/or gaps in the staffing model. Consider the following

ques"ons to guide your response:

What kind of lapses and/or gaps are possible across the en"re process?

What are the possible reasons behind these lapses and/or gaps?

5. Impact of Failure: Discuss the impact of any failure in the Claims Produc"on and Claims Submission areas of the

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revenue cycle. Consider the following ques"ons to guide your response:

What are some of the possible events of failure that could happen in the first two areas?

Who would be impacted by such events?

6. Financial Impact of Declined Claims: Discuss the financial impact of ini"ally declined claims and delayed payments to

healthcare organiza"ons. Consider the following ques"ons to guide your response:

Do healthcare organiza"ons face the same financial impact for governmental and private insurance claims?

What steps can be taken by the backend process staff and by leadership to ensure these delays do not

happen?

All the claims in your deliverable should be evidence based. Your cita"ons should be from your independent search for

evidence (not from the textbook, or module resources) of credible sources and be current within the last five years. You are

required to cite between 3-5 resources, with a minimum of three sources, at least one which is not also one of your Project

One resources. Refer to the IHP 630 Library Guide located in the Start Here sec"on of the course for addi"onal support.

What to Submit

Submit your analysis report as a 5- to 6-page Microso$ Word document with double spacing, 12-point Times New Roman

font, and one-inch margins. Sources should be cited according to APA style.

Criteria Exemplary (100%) Proficient (90%) Needs

Improvement (70%) Not Evident (0%) Value

Staffing Competencies

Exceeds proficiency in an excep"onally clear and insigh%ul manner, using industry-specific language

Describes the staffing competencies needed for hiring team members in the back-end revenue cycle

Shows progress toward proficiency, but with errors or omissions

Does not a&empt criterion

10

Revenue Integrity Exceeds proficiency in an excep"onally clear and insigh%ul manner, using industry-specific language

Explains the importance of each area of the revenue cycle for preserving revenue integrity

Shows progress toward proficiency, but with errors or omissions

Does not a&empt criterion

10

Role of Leadership

Exceeds proficiency in an excep"onally clear and insigh%ul manner, using industry-specific language

Explains the role of leadership in ensuring staffing competencies

Shows progress toward proficiency, but with errors or omissions

Does not a&empt criterion

10

Lapses and Preven!on

Exceeds proficiency in an excep"onally clear and insigh%ul manner, using industry-specific language

Iden"fies processes to prevent lapses and/or gaps in the staffing model

Shows progress toward proficiency, but with errors or omissions

Does not a&empt criterion

15

Impact of Failure Exceeds proficiency Discusses the Shows progress Does not a&empt 15

Module Five Project Prepara!on Rubric

5/22/23, 2:57 PM Page 2 of 3

in an excep"onally clear and insigh%ul manner, using industry-specific language

impact of any failure in the Claims Produc"on and Claims Submission areas of the revenue cycle

toward proficiency, but with errors or omissions

criterion

Financial Impact of Declined

Claims

Exceeds proficiency in an excep"onally clear and insigh%ul manner, using industry-specific language

Discusses the financial impact of ini"ally declined claims and delayed payments to healthcare organiza"ons

Shows progress toward proficiency, but with errors or omissions

Does not a&empt criterion

15

Ar!cula!on of Response

Exceeds proficiency in an excep"onally clear and insigh%ul manner

Clearly conveys meaning with correct grammar, sentence structure, and spelling, demonstra"ng an understanding of audience and purpose

Shows progress toward proficiency, but with errors in grammar, sentence structure, and spelling, nega"vely impac"ng readability

Submission has cri"cal errors in grammar, sentence structure, and spelling, preven"ng understanding of ideas

10

Scholarly and Professional

Sources

Incorporates more than three scholarly, current (within the last five years) sources, or use of sources is excep"onally insigh%ul

Incorporates three scholarly, current (within the last five years) sources that support claims

Incorporates fewer than three scholarly, current (within the last five years) sources, or not all sources support claims

Does not incorporate sources

10

APA Style Formats in-text cita"ons and reference list according to APA style with no errors

Formats in-text cita"ons and reference list according to APA style with fewer than five errors

Formats in-text cita"ons and reference list according to APA style with five or more errors

Does not format in- text cita"ons and reference list according to APA style

5

Total: 100%

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