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Introduction
The financial health of the health care organization depends upon its ability to generate consistent and recurring funds from the services it provides. Collectively referred to as the revenue cycle (RCM), critical stages in this process include:
- Patient registration.
- Collection of demographics and payor source.
- Rendering services.
- Documenting services.
- Establishing charges.
- Preparing the claim or bill.
- Submitting the claim.
- Receiving payment.
- Managing accounts receivable.
Decreasing payment delays and lost revenues is a point of interest for many health care managers tasked with oversight of the RCM process. Innovative approaches in technology have assisted with streamlining the RCM process and allowed for automation of many processes, resulting in expedited processing and quick remittance.Managed care dollars represent a significant portion of all health care organizations’ reimbursements. As a result, health care organizations seek to establish contracts with large managed care organizations (MCOs). Negotiating and securing contracts with MCOs is important for several reasons, including preserving revenues, enhancing patient satisfaction, and generating additional sources of revenue.All contracts will contain language outlining the administration of the contract along with the payment schedule. While the payment schedule may be seen as the most important element, the terms outlined within the contract are equally as vital to the financial success of the organization.This assessment focuses on the revenue cycle and how technological innovations have impacted reimbursement for health care organizations. You will take on the role of a patient access supervisor. One of your job functions entails educating new hires about the revenue cycle process.
Demonstration of Proficiency
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
- Competency 3: Explain the organizational revenue cycle process.
- Explain the purpose of each step in the revenue cycle process.
- Describe key responsibilities of individuals who work in the revenue cycle process.
- Explain the consequences to the organization of failing to fulfill key responsibilities in the revenue cycle process.
- Explain additional steps and challenges in the revenue cycle process when working with an uninsured patient.
- Competency 4: Communicate in a manner that is scholarly, professional, and respectful of the diversity, dignity, and integrity of others and is consistent with the expectations of health care professionals.
- Adhere to the rules of grammar, usage, and mechanics.
- Apply APA formatting to in-text citations and references.
Instructions
For this assessment, prepare a 10-slide PowerPoint presentation outlining the various steps of the revenue cycle. For the scenario, imagine you are a patient access supervisor who must educate a group of new hires about the revenue cycle process. The presentation should include:
- The revenue cycle process.
- Their potential responsibilities.
- Why the process is important to a care organization.
- Challenges that they might face in their work.
When structuring your presentation, consider the following points and questions to ensure that you are meeting the scoring guide criteria:
- Explain the purpose of each step in the revenue cycle process.
- “Explain” means to make (an idea, situation, or problem) clear to someone by describing it in more detail or revealing relevant facts or ideas.
- The steps within the revenue cycle process including admissions, case management, documentation, coding, billing, and other steps.
- Describe key responsibilities of individuals who work in the revenue cycle process.
- “Describe” means to give an account in words of (someone or something), including all the relevant characteristics, qualities, or events.
- Describe key components (such as verifying insurance, financial counseling, coding of documented services provided, and others) and who is responsible (individuals such as coders, registration clerk, and others).
- Explain the consequences to the organization of failing to fulfill key responsibilities in the revenue cycle process.
- Explain additional steps and challenges in the revenue cycle process when working with an uninsured patient.
- Provide information for the new staff regarding options available for the uninsured.
- Identify any additional steps throughout the revenue cycle that one must be aware of when working with an uninsured patient.
- Identify the challenges that exist for the revenue cycle due to the delivery of uncompensated care.
- Adhere to the rules of grammar, usage, and mechanics.
- “Grammar” refers to the basic rules for how sentences are constructed and how words combine to make sentences (for example, word order, case, and tense).
- “Usage” refers to correct word choice and phrasing, particularly with regard to the meanings of words and phrases.
- “Mechanics” refers to correct use of capitalization, punctuation, and spelling.
- Apply APA formatting to in-text citations and references.
- Be sure to include a separate references slide.
Record audio for this presentation. You can record directly into your PowerPoint presentation, or through Kaltura. You may wish to consult these resources before starting your assessment:
Submit your completed PowerPoint Presentation as an attachment in the assessment.
Additional Submission Requirements
- Media presentation: Use the Revenue Cycle Process template [PPTX] provided. Create 10 slides you would present in 10–20 minutes, plus an APA-formatted reference slide at the end of the presentation.
- Resources: Cite at least three scholarly resources.
- Your textbook can be one of the three.
- APA guidelines: Use APA style for references and citations. When appropriate, use APA-formatted headings. For more information, refer to the APA resources located in the courseroom navigation panel.
- Font and font size: Times New Roman, using appropriate size and weight for a presentation, generally 24–28 points for headings and no smaller than 18 points for bullet-point text.
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SCORING GUIDE
Use the scoring guide to understand how your assessment will be evaluated.VIEW SCORING GUIDE
- CRITERIANON-PERFORMANCEBASICPROFICIENTDISTINGUISHEDExplain the purpose of each step in the revenue cycle process.Does not attempt to describe the purpose of each step in the revenue cycle process.Attempts to describe the purpose of each step in the revenue cycle process, but the description is inaccurate or incomplete.Explains the purpose of each step in the revenue cycle process.Explains the purpose of each step in the revenue cycle process and provides relevant examples supported by current literature.Describe key responsibilities of individuals who work in the revenue cycle process.Does not attempt to identify key responsibilities of individuals who work in the revenue cycle process.Attempts to identify key responsibilities of individuals who work in the revenue cycle process.Describes key responsibilities of individuals who work in the revenue cycle process.Describes key responsibilities of individuals who work in the revenue cycle process and provides relevant examples supported by current literature.Explain the consequences to the organization of failing to fulfill key responsibilities in the revenue cycle process.Does not attempt to describe the consequences to the organization of failing to fulfill key responsibilities in the revenue cycle process.Attempts to describe the consequences to the organization of failing to fulfill key responsibilities in the revenue cycle process, but the description is inaccurate or incomplete.Explains the consequences to the organization of failing to fulfill key responsibilities in the revenue cycle process.Explains the consequences to the organization of failing to fulfill key responsibilities in the revenue cycle process and provides relevant examples.Explain additional steps and challenges in the revenue cycle process when working with an uninsured patient.Does not attempt to describe additional steps and challenges in the revenue cycle process when working with an uninsured patient.Attempts to describe additional steps and challenges in the revenue cycle process when working with an uninsured patient, but the description is inaccurate or incomplete.Explains additional steps and challenges in the revenue cycle process when working with an uninsured patient.Explains additional steps and challenges in the revenue cycle process when working with an uninsured patient and provides relevant examples.Adhere to the rules of grammar, usage, and mechanics.Does not adhere to the rules of grammar, usage, and mechanics.Errors in grammar, usage, and mechanics inhibit readability and comprehension and detract from good scholarship.Adheres to the rules of grammar, usage, and mechanics.Exhibits strict and nearly flawless adherence to the rules of grammar, usage, and mechanics.Apply APA formatting to in-text citations and references.Does not apply APA formatting to in-text citations and references.Applies APA formatting to in-text citations and references incorrectly or inconsistently, detracting noticeably from good scholarship.Applies APA formatting to in-text citations and references.Exhibits strict and nearly flawless adherence to APA formatting of in-text citations and references.
Expert Solution Preview
Answer:
Introduction:
In this assessment, as a patient access supervisor, I have to prepare a PowerPoint presentation to educate new hires about the revenue cycle process. The revenue cycle (RCM) is a critical process for healthcare organizations, as it enables them to generate consistent and recurring funds from the services they provide. There are many steps involved in the RCM that require attention, such as patient registration, collecting demographics and payor source, rendering services, documenting services, establishing charges, preparing the claim or bill, submitting the claim, receiving payment, and managing accounts receivable. The purpose of this assessment is to explain the steps of the revenue cycle, describe the key responsibilities of individuals working in the revenue cycle process, explain the consequences of failing to fulfill the key responsibilities of the revenue cycle process, and describe additional steps and challenges that exist in the revenue cycle process when working with an uninsured patient.
Purpose of each step in the revenue cycle process:
The revenue cycle is a comprehensive process that involves many steps, including:
1. Admissions: The admissions process is the first step in the revenue cycle. In this step, patients are registered and assigned an account number.
2. Case management: In this step, the case manager coordinates the patient’s care and determines what services are needed.
3. Documentation: Documentation is an important step in the revenue cycle process, where services are recorded to ensure accurate billing.
4. Coding: Coding is a process where the services provided to the patient are assigned a code, which is used to generate a bill.
5. Billing: Billing is the process of preparing the bill or claim and ensuring it is submitted to the correct payor source.
6. Collecting payment: Once the claim has been submitted, the healthcare organization receives payment for services provided.
7. Managing Accounts Receivable: Managing accounts receivable is an ongoing process for the healthcare organization to ensure they receive payment in a timely and efficient manner.
Key responsibilities of individuals who work in the revenue cycle process:
Individuals working in the revenue cycle process include patient access representatives, insurance verifiers, coders, billers, and collections specialists. Each of these individuals has specific responsibilities to ensure that the revenue cycle process is successful, including:
1. Patient access representatives: They gather information during the registration process and ensure that the patient information is accurate.
2. Insurance verifiers: They contact the patient’s insurance company to verify coverage and benefits.
3. Coders: Coders assign codes to services provided to ensure billing accuracy.
4. Billers: Billers submit claims to payors, ensuring they are paid on time.
5. Collections specialists: They work to collect outstanding payments from patients and payors.
Consequences of failing to fulfill key responsibilities in the revenue cycle process:
Failing to fulfill key responsibilities in the revenue cycle process can result in financial losses for the healthcare organization. Late payments, denials, and rejections of claims can impact the revenue cycle process, leading to lost revenue for the healthcare organization. In addition, failing to ensure accurate patient information during the registration process can lead to denied claims and lengthy payment delays.
Additional steps and challenges in the revenue cycle process when working with an uninsured patient:
When working with an uninsured patient, additional steps and challenges exist within the revenue cycle process. For instance, financial counseling becomes a vital step in the process to ensure that the patient knows how much they owe and what payment options are available to them. Additionally, the healthcare organization must consider options for the uninsured, such as payment plans or charity care, to minimize losses and provide care to the uninsured.
Conclusion:
The revenue cycle process is an important process for healthcare organizations to ensure financial stability. As a patient access supervisor, it is essential to educate new hires about this process to ensure they understand the critical steps and key responsibilities involved in the process. By doing so, the revenue cycle can be streamlined with fewer errors and increased revenue for the healthcare organization.
