Understanding the Health Care Reform Act

HFMA

Revenue Cycle

Revenue Cycle Functions

Fundamental functions: Ø Data collection Ø Charge capture Ø A/R posting Ø Collections/reimbursement

Revenue Cycle Functions

Data collection Ø Access

-  Adequate and correct patient information -  Example of complete information: Name and

other identifiers such as sex, date of birth, race, social security number, and marital status…

Revenue Cycle Functions

Data collection Ø Access

-  Accurate information: Key information should be verified

HIM & Medical Record

Revenue Cycle Function

Data Collection Charge Capture in Charge Master

Patient Financial Services

Revenue Cycle Functions

PFS: Ø Gather charges for services provided Ø Assemble charge in proper format on the

claim Ø Submit timely claims to payors Ø Collect balances due and manage AR

Revenue Cycle Function

Pre- In- Discharged Bed admission Admission house Discharge (not final billed) request

Billed Account Account Bill print A/R Bill submit follow-up collection

Account $ Payment resolution

Revenue Cycle Practicum