Discussion Reply- Response 1-2 paragraphs with 1-2 references

Alexandria Airo

Hello Everyone!

This week the discussion that we are to complete is about health insurance plans. Health insurance plans are involved with reimbursing healthcare providers. This can have an impact on the revenue cycle. According to Principles of Healthcare Reimbursement, the revenue cycle is the set of responsibilities and actions used to produce revenue in a healthcare organization that include several major components as follows: “pre-claims submission, claims processing, accounts receivable, and claims reconciliation and collection” (Casto, 2018, pg. 233-234). This process is a beginning to end of a patient’s account for payments. Part of this process for the revenue cycle includes maintenance, compliance, and a key member, coding management (Casto, 2018). Therefore, it is important that there maintains a process of the revenue cycle that is not disrupted, is in compliance, and has better methods or actions used within it. A well – functioning revenue cycle is important for the success of any organization.

As an administrator of a physician’s office, reimbursement is viewed in the form of an aging schedule. After observing current procedures, there are improvements needed for the process in the front office. The improvement that can be recommended to implement in the front office staff as it relates to the processes of the revenue cycle would be to make sure that the staff is well-educated and trained on billing and collection of payment, so that they can work more effectively and efficiently. The efficiency of a healthcare organization’s billing processes is crucial and has a critical effect on its financial performance (Advanced MD, 2018). Additionally, in order to get to and maintain a successful billing operation, there is a need for educated and trained staff. When there is an administrative staff that understands and can follow the correct procedures, it can help with ensuring that bills, claims, and any other requests that are required are completed and tendered successfully. Essentially, an educated and trained staff provides a strong revenue cycle.

Specifically, there are a few areas that can contribute to a strong revenue cycle: workflow and use of technology (Advanced MD, 2018). Workflow especially, can positively impact the revenue cycle by having front office staff that can complete the tasks required including verifying and collecting health insurance and co-pays, documentation of visits using correct codes, and using correct activities to submit claims and managing the collections process (Advanced MD, 2018). However, a failure in completing the processes and understanding them can interrupt and change the revenue cycle and lead to a financial upset in the organization (Advanced MD, 2018). Thus, education and training are crucial to avoid financial issues. Part of this improvement on ensuring the staff is educated and trained is also ensuring that there is an organized revenue process. This is achieved by making sure that the administrative staff has looked over requirements and procedures and understands the process. Overall, a well – trained, educated, and experienced team is the most critical driver to positive revenue (Advanced MD, 2018). This can contribute to a more successful and positive financial impact on the healthcare organization.

Hope that you all have a wonderful week!

- Alexandria

References:

Advanced MD. (2018, November 19). Revenue cycle management 101. NueMD. https://nuemd.com/revenue-cycle-management/rcm-101 .

Casto, A. B. (2018). Principles of healthcare reimbursement. MBS Direct Vital Source (6th ed.). American Health Information Management Association AHIMA. https://mbsdirect.vitalsource.com/#/books/9781584266648/cfi/6/8!/4/2/2/2@0:0