Billing Policies and Procedures

CRITERIA

NON-PERFORMANCE

BASIC

PROFICIENT

DISTINGUISHED

Develop a step-by-step process for a revenue cycle. 14%

Does not develop a step-by-step process for a revenue cycle.

Develops a process for a revenue cycle, but omissions and/or errors exist.

Develops a step-by-step process for a revenue cycle.

Develops a step-by-step process for a revenue cycle. Process explains each step’s function.

Recommend a pricing structure method. 14%

Does not recommend a pricing structure method.

Describes one or more pricing structure methods, but does not recommend one.

Recommends a pricing structure method.

Recommends a pricing structure method. Recommendation explains how the pricing structure method supports the organization’s financial strategies.

Explain how billing process changes benefit patients, physicians, and the clinic. 12%

Does not explain how billing process changes benefit patients, physicians, and the clinic.

Explains how billing process changes benefit patients, physicians, and the clinic in minimal depth and detail.

Explains how billing process changes benefit patients, physicians, and the clinic.

Explains how billing process changes benefit patients, physicians, and the clinic. Explanation includes multiple examples and references to current scholarly and/or authoritative sources.

Explain the factors to consider for insurance contract negotiations. 13%

Does not explain the factors to consider for insurance contract negotiations.

Explains the factors to consider for insurance contract negotiations in minimal depth and detail.

Explains the factors to consider for insurance contract negotiations.

Explains the factors to consider for insurance contract negotiations. Explanation identifies the major payer categories appropriate for the practice.

Explain a process for handling private pay and charity care. 13%

Does not explain a process for handling private pay and charity care.

Explains a process for handling private pay and charity care in minimal depth and detail.

Explains a process for handling private pay and charity care.

Explains a process for handling private pay and charity care. Explanation shows how the process fits into the organization’s financial strategies.

Recommend a billing software system. 14%

Does not recommend a billing software system.

Describes one or more billing software systems, but does not recommend one.

Recommends a billing software system.

Recommends a billing software system. Recommendation compares the benefits and limitations of each in terms of the organization’s needs and financial strategies.

Write content clearly and logically with correct use of grammar, punctuation, and spelling. 15%

Does not write content clearly and logically or with correct use of grammar, punctuation, and spelling.

Writes content; however, lapses, omissions, and/or errors exist.

Writes content clearly and logically with correct use of grammar, punctuation, and spelling.

Writes clear, logical, and error-free content. Provides relevant evidence to support proposed changes.

Format citations and references in APA style. 5%

Does not format citations and references in APA style.

Formats citations and reference in APA style; however, omissions and/or errors exist.

Formats citations and references in APA style.

Formats citations and references in APA style, without errors.