M1 revenue service

Overview

Healthcare revenue-cycle management is a strictly managed and closely monitored process that impacts the pa!ents

(beneficiaries), providers, or payers. Therefore, it is important for both stakeholders to understand the other’s perspec!ve, so

that they have a more holis!c view of the en!re process. The following flowcharts capture the revenue cycle from the

pa!ent’s perspec!ve and the facility’s perspec!ve.

Text-only versions of the images below are available: Module One Ac!vity Revenue Cycle Images Text-Only Version.

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Casto, A. (2021). Principles of Healthcare Reimbursement (7th Ed). American Health Informa!on Management Associa!on

(AHIMA). h"ps://bookshelf.vitalsource.com/books/9781584268017

Reproduced with permission from AHIMA.

This ac!vity will help you describe the revenue-cycle process and healthcare reimbursement, as well as differen!ate the

components of revenue-cycle processes from various perspec!ves.

The ac!vity will help you prepare for sec!on 4 (Revenue Cycle Process) in the course project that you will be submi$ng in

Module Nine.

Direc!ons

Create a compara!ve-analysis document for the revenue cycle from both the pa!ent perspec!ve and either a facility or

provider perspec!ve. Include a Venn diagram to illustrate your analysis. Then, analyze the revenue-cycle components from a

third-party payer perspec!ve.

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. Venn Diagram: Create a Venn diagram to compare and contrast the revenue cycle from the pa!ent’s perspec!ve and

the provider or facility’s perspec!ve. Refer to Figure 1.7A and Figure 1.7B in the Overview sec!on of this rubric to

create the diagram. Include the following details in your response:

A. Label the sec!ons appropriately in the Venn diagram. Your diagram should clearly bring out the common

aspects and the differences between the two perspec!ves.

B. Number each sec!on within the Venn diagram and list the components corresponding to each number below

Figure1.7B.Detailedrevenuecyclefromfacilityorproviderperspective

Patientisscheduledand preauthorized

Patientisadmitted, demographicandpayer informationcollected, costsharingcollected

Medicalrecordsare reviewedandcoded

Claimisproduced, audited(scrubbed),and

corrected

Accountsaremanaged untilpaymentsare received

Paymentsand remittanceadviceare receivedfrompayer

Servicesaredeliveredto patient,chargesare

captured

Claimistransmittedto Payer

Outstandingcostsharing paymentsarecollected frompatient

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the diagram. This will help avoid clu"er within your diagram.

2. Comparison of Perspec!ves: Explain how the pa!ent perspec!ve is like the facility or provider perspec!ve in

ensuring revenue integrity. Consider the following ques!ons to guide your response:

Have you covered all the points listed in the overlapping sec!on of the Venn diagram?

Are these components common to both the perspec!ves of the revenue cycle?

How do these aspects ensure revenue integrity?

3. Contrast Between Perspec!ves: Explain how the pa!ent perspec!ve differs from the facility or provider perspec!ve

in ensuring revenue integrity. Consider the following ques!ons to guide your response:

Have you addressed all the points listed in the non-overlapping sec!ons of your Venn diagram?

Are these components of the revenue cycle unique to either perspec!ve?

How do these aspects ensure revenue integrity?

4. Significance for Third-Party Payer: Interpret the revenue cycle from the perspec!ve of a third-party payer. Deduce

your interpreta!on based on the informa!on in the Venn diagram. Consider the following ques!ons to guide your

response:

Which areas of the revenue cycle would be the most relevant for the payer?

How do these areas impact healthcare reimbursement?

What happens if one of the areas in the revenue cycle is omi"ed or not completed correctly?

Your analysis 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 a

minimum of two sources, at least one of which should be separate from your own research. 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 compara!ve analysis as a 2- to 3-page Microso% Word document (one of these pages must be your completed

Venn diagram) with double spacing, 12-point Times New Roman font, and one-inch margins. Add a !tle page. Sources should

be cited according to APA style.

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

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

Venn Diagram Exceeds proficiency in an excep!onally clear and insigh&ul manner, using industry-specific language

Creates a Venn diagram to compare and contrast the revenue cycle from the pa!ent’s perspec!ve and the provider or facility’s perspec!ve

Shows progress toward proficiency, but with errors or omissions

Does not a"empt criterion

20

Comparison of Perspec!ves

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

Explains how the pa!ent perspec!ve is like the facility or provider perspec!ve in ensuring revenue integrity

Shows progress toward proficiency, but with errors or omissions

Does not a"empt criterion

20

Contrast Between Exceeds proficiency Explains how the Shows progress Does not a"empt 20

Module One Ac!vity Rubric

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Perspec!ves in an excep!onally clear and insigh&ul manner, using industry-specific language

pa!ent perspec!ve differs from the facility or provider perspec!ve in ensuring revenue integrity

toward proficiency, but with errors or omissions

criterion

Significance for Third-Party Payer

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

Interprets the revenue cycle from the perspec!ve of a third-party payer

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 Sources Incorporates more than two scholarly, current (within the last five years) sources, or use of sources is excep!onally insigh&ul

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

Incorporates fewer than two 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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