2 assignments due in 36 hours
combs
IR3004_c.docx
Written Response Submission Form
Your Name: First and last
Your E-Mail Address: Your email here
Instructions
Write your responses where it reads “Enter your response here.” Write as much, as needed, to satisfy the requirements indicated. Each item contains the Rubric, which will be used to evaluate your responses.
Item 1
In your own words, explain the importance of the revenue cycle and describe the different components that are included within it. (2–3 paragraphs)
Your Response
Enter your response here.
Rubric
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0 Not Present |
1 Needs Improvement |
2 Meets Expectations |
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Module 1: Revenue Cycle Management |
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In your own words, explain the importance of the revenue cycle.
LO1.2: Analyze the importance of the revenue cycle. |
Response is not present. |
Response is inaccurate or incomplete. |
Response accurately and fully explains the importance of the revenue cycle. |
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Describe the different components that are included in the revenue cycle.
LO1.2: Describe the components of the revenue cycle. |
Response is not present. |
Response is inaccurate or incomplete. |
Response accurately and fully explains each of the components within the revenue cycle. |
Item 2
Sally is the Office Manager working for a pediatric otolaryngologist, Dr. Johnson, who commonly treats young children who have chronic otitis media (ear infections). It’s the beginning of February and Sally was just given the end of month reports from the staff to review. She has been eager to get the reports because revenue is down, and she wants to know why. As she glances through the reports, she notices that BMTT (bilateral myringotomy and tympanostomy with tubes) surgeries are not getting paid.
The problem could stem from several reasons including:
1. A change in codes billed to payers
2. Payer guidelines
3. Lack of pre-authorization
Consider each of the reasons listed above and explain how you would address the issue to correct the revenue cycle. (Note: You will attempt to correct the revenue cycle from each of the three perspectives.). Cite at least one appropriate resource in your response and include the reference at the end of the document. (5–6 paragraphs)
Your Response
Enter your response here.
Rubric
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0 Not Present |
1 Needs Improvement |
2 Meets Expectations |
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Module 2: Best Practices in Revenue Cycle Management |
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Explain how you would address the impact of changes in codes billed to payers issue that is impacting revenue.
LO2.1: Recommend strategies for addressing issues relating to changes in codes billed to payers. |
Response is not present. |
Response recommends strategies that are unclear or inappropriate. |
Response recommends clear and appropriate strategies for addressing issues related to changes in codes billed to payers. |
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Explain how you would address the payer guidelines issue that is impacting revenue.
LO2.2: Recommend strategies for addressing issues related to payer guidelines. |
Response is not present. |
Response recommends strategies that are unclear or inappropriate. |
Response recommends clear and appropriate strategies for addressing issues related to payer guidelines. |
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Explain how you would address the lack of pre-authorization issue that is impacting revenue.
LO2.3: Recommend strategies for addressing issues related to lack of pre-authorization. |
Response is not present. |
Response recommends strategies that are unclear or inappropriate. |
Response recommends clear and appropriate strategies for addressing issues related to lack of pre-authorization. |
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Cite at least one appropriate resource in your response.
LO2.4: Cite appropriate resources. |
Response is not present. |
Response cites a resource incorrectly, or the resource cited is inappropriate. |
Response cites at least one appropriate resource within the response. |
Item 3
Tony is a consultant who was hired to detect and address an ongoing problem. The accounts receivable has been increasing month over month in a Family Care Clinic.
Tony has already reviewed a few reports given to him by Dr. Nguyen, and the problem could stem from several reasons:
1. Kelly, the checkout clerk, is not collecting the patient’s copay/coinsurance at the time of the office visit2. All checkout clerks collecting the wrong amount prior to surgery. Very few of Dr. Nguyen’s patients are paying their bills.
Consider each of the three reasons and explain how you would address each issue to correct the revenue cycle. (Note: You will attempt to correct the revenue cycle from each of the three perspectives.). Cite at least one appropriate resource in your response and include the reference at the end of the document. (5–6 paragraphs)
Your Response
Enter your response here.
Rubric
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0 Not Present |
1 Needs Improvement |
2 Meets Expectations |
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Module 2: Best Practices in Revenue Cycle Management |
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Explain how you would address the not collecting co-payments/coinsurance at checkout issue that is impacting accounts receivable.
LO2.5: Recommend strategies for addressing issues relating to not collecting co-payments/coinsurance. |
Response is not present. |
Response recommends strategies that are unclear or inappropriate. |
Response recommends clear and appropriate strategies for addressing issues related to not collecting co-payment/coinsurance at the time of checkout. |
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Explain how you would address the incorrect payments prior to surgery issue that is impacting accounts receivable.
LO2.6: Recommend strategies for addressing issues related to collecting incorrect payment amounts prior to surgery. |
Response is not present. |
Response recommends strategies that are unclear or inappropriate. |
Response recommends clear and appropriate strategies for addressing issues related to collecting incorrect amounts at the time of surgeries. |
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Explain how you would address the nonpayment of bills issue that is impacting accounts receivable.
LO2.7: Recommend strategies for addressing issues relating to nonpayment of bills by patients. |
Response is not present. |
Response recommends strategies that are unclear or inappropriate. |
Response recommends clear and appropriate strategies for addressing issues related to patients failing to pay bills. |
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Cite at least one appropriate resource in your response.
LO2.8: Cite appropriate resources. |
Response is not present. |
Response cites a resource incorrectly, or the resource cited is inappropriate. |
Response cites at least one appropriate resource within the response. |
References
Provide a citation for each resource you used to write your response to this Assessment. The following citation has been provided as an example:
· Ellison, A. (2018). 4 best practices to elevate your hospital’s revenue cycle performance. Retrieved from https://www.beckershospitalreview.com/finance/4-best-practices-to-elevate-your-hospital-s-revenue-cycle-performance.html
Mastery Rubric
In order to achieve mastery of this Competency, you must achieve a “2” on every rubric row in addition to meeting the additional expectation indicated in the Mastery Rubric.
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Mastery Rubric |
No |
Yes |
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Exceeds Expectations: Solving Problems |
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Learning Objective – Develop a logical, consistent plan to solve problems. |
Responses do not recommend thoughtful, thorough, and creative strategies for finding and fixing issues within the revenue cycle. |
Responses recommend thoughtful, thorough, and creative strategies for finding and fixing issues within the revenue cycle. |
Professional Skills Building
The faculty Assessor will provide feedback based on the following Professional Skills: Written Communication, Information Literacy, and Inquiry & Analysis. Although the feedback is here to inform the development of your skills, it is not a barrier to achieving the Competency, unless the writing is too poor to be able to score the content of the Assessment. Review the rubric and check your work based on the learning objectives listed. If you are concerned that your writing will not meet these expectations yet, reach out to your Faculty Subject Matter Expert (SME) so he or she can work with you to further develop this important professional skill.
It is highly recommended that you use this opportunity to practice these important skills in the context of this Competency Assessment in order to receive feedback about your current level of proficiency.
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