I selected the article, Revenue Cycle Management Compliance-How
Policies and Procedures Provides a Solid and Effective Foundation.
This article was specific to healthcare revenue cycle management. It
gave an overview of the complexity of its revenue cycle which
includes billing to a third party such as an insurance company. The
healthcare provider must have up to date and accurate information
from their patients and status of claims to the patients’ insurance
providers. There can be back and forth between the patient and
insurance provider on what services are being covered by the
insurance and what the patient is responsible for. On top of this, they
must be in compliance with regulations and laws regarding patient
identity and type of care received.
Having an enterprise resource planning (ERP) system is needed. The
healthcare workers can input the services that have been
administered, billing department can assess and code the services to
align with the insurance provider’s understanding of service, and then
a claim is sent to the insurance provider. Once the insurance provider
provides full or partial payment, it is applied to the patient’s balance.
If partial payment is provided, the healthcare provider will bill the
patient with the remaining balance. The ERP will track the status of
the claim, and customer service can have access to this information if
a patient inquires (Thomas, 2022).
The article expands on the importance of policies and procedures
regarding the revenue cycle. It includes limiting authorization of
functionality within the ERP system (Thomas, 2022). The revenue
cycle impacts the expenditure cycle and production cycle. If there is
an outstanding balance in accounts receivables, that limits the
company’s ability to spend on needs within the company (Romney et
al, 2020).
Reference
Romney, M. B., Steinbart, P. J., Summers, S. L., & Wood, D. A. (2020).
Accounting Information Systems (15th ed.). Pearson Education (US).
https://mbsdirect.vitalsource.com/books/9780135573082
Thomas, S.E. (2022).Revenue Cycle Management Compliance-How
Policies and Procedures Provides a Solid and Effective Foundation
Health Care Compliance. September-October. Retrieved January 4,
2023 https://eds-s-ebscohost
com.ezproxy.snhu.edu/eds/pdfviewer/pdfviewer?vid=4&sid=118822
8d-278b-4bfd-ba40 5000453b3afe%40redis
