HI215 Unit 8: Assignment

HI215 Unit 8: Assignment

Identify the phases of the revenue management life cycle and the activities included in each phase

The front-end is the first phase, which is the payer negotiation phase that occurs outside the patient encounter. The revenue cycle is the middle phase, which involves case management and is based on clinical documentation. In this phase both hard and soft coding are conducted before requesting for proper payment. The final phase is the back-end, which happens in patient financial services. In this phase corrections, bill, claims, and payments are handled. In the final phase patient services processes and sends bills to the insurance company and it is engaged in fixing and correcting errors on the claim (Malmgren & Solberg, 2010).

Discuss the interrelationships that exist among the revenue cycle activities in the different phases, and the impact they can have for the organization’s financial health.

The revenue cycle engages varieties of approaches which work together to ensure and enhance the financial health of an organization. From its beginning, the revenue cycle is concerned with the financial issues related to the patient. This process continues until it is taken over byte management, which is concerned with the analysis of the revenue cycle. The operation of the management continues until a patient’s account is closed. Late charges as part of the percentage of the total charges and charity care are two most important revenue cycles that enhance the financial health of an organization (Malmgren & Solberg, 2010).

Identify tools and techniques used to improve health care finance and discuss the role technology plays in successful revenue cycle management.

Key performance indicators are part of the important tools and techniques used in improving the financial operations of health care organizations. These indicators allow healthcare organizations to engage in benchmarking of data. Root cause analysis is also an essential technique in the management of health care finances because it allows for different forms of accountability across the revenue cycle management (Malmgren & Solberg, 2010).

Review two of the monitors and describe their purpose and how they “monitor” the finance health of an organization. Which monitors do you feel are the most important? Why?

Charity care and patient access insurance verification are two of the monitors that play and essential role in the financial health of organizations. Patient access insurance verification rates are involved in monitoring the efficiency and accuracy of the patient verification process. Through this monitoring technique, health care organizations have the ability of ensuring that the insurance companies pay for the medical expenses of the patients they insure. This process involves an assessment of the types of illnesses that different insurance companies cover and ensuring that they act according to the expectations of the patients when seeking medical help. Despite its essence in enhancing the financial health of an organization, patient access insurance verification is ineffective compared to the charity care. This is because the latter provides financial assistance for those who are unable to pay or those in need of help to access medical care. It would be reputable for every medical facility to embrace charity care to enhance their ability to provide care and assistance to more patients (Malmgren & Solberg, 2010).

Part 2

What is a charge description master and why do healthcare facilities develop charge masters?

A charge description master is a list of all the activities and health care operations that can be executed in a health care facility. It also includes the financial charges that those seeking the services would incur. Through the development of the charge description master, it becomes easier for healthcare facilities to engage in effective claim processing (Malmgren & Solberg, 2010).

How might an inaccurate charge description master affect facility reimbursement?

An inaccurate charge description master has the ability of affecting the financial health and operationalization of a health care facility. This is because inaccuracies in the charges of the activities or operations of an organization increase the possibility of processing false claims. In such situations, it becomes impossible for e facility to be paid for the services offered. In addition, an inaccurate charge description master may also under charge or over charge a patient for services offered making it difficult for the insurance companies to be involved in trustworthy financial relationships with the facility (Malmgren & Solberg, 2010).

What are the typical items on the charge description master?

On the charge description master (CDM), the typical items include medication, devices, services, and supplies. In some instances, the CDM may also include other elements such as codes for the items, the department in charge of those items, the description of service items, general ledger number, the service item number the process and the revenue code. The essence of this coding process of items in the CDM list is that they allow for easy processing of claims especially when the facility is dealing with a large number of claims (Malmgren & Solberg, 2010).

Who is responsible for maintaining the charge description master?

The process of maintaining the CDM to ensure it is effective in the operationalization of the facility is under the responsbility of multiple departs within the facility. The multidisciplinary approach to maintenance is because of the underlying requirements of a team of experienced experts in varieties of disciplines such as health records, clinical documentation, coding, billing regulations and clinical procedures. Cooperative efforts of these experts enhance the possibility of developing an updated charge description master (Malmgren & Solberg, 2010).

Has the use of the charge description master made manual coding by HIM coders obsolete? True or False?

It is false because codes are still in need of the manual coding process especially when engaged in coding of items that are not listed. Furthermore, for some codes there is need for the manual verification process as a way gauging and maintaining their level of accuracy. The manual coding process is still effective in maintaining the financial health of a facility because it helps in the identification of coding areas that have been omitted by the charge description master. Through this approach, it becomes easier for a facility to engage in effective determination of the process of charges in the charge description master to minimize inaccuracies (Malmgren & Solberg, 2010).

References

Malmgren, C & Solberg, J. (2010). Revenue Cycle Management. AHIMA Press 

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