Question

Write a short essay on the importance of revenue cycle management and the impact it can have on the healthcare organization. and respond about these 4 area's in your post

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

2. 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.

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

4. 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? Support your answers.

Answer 1

Healthcare revenue cycle management is the financial process that facilities use to manage the administrative and clinical functions associated with claims processing, payment, and revenue generation.

Revenue cycle management(RCM) has a significant impact on the healthcare industry. RCM includes the use of technology to keep track of any claims through their entire lifecycle, ensure payments are collected, and address any denied claims. Revenue cycle management tools allow health care providers doing the billing to follow the process and identify any issues quickly, allowing for the steady stream of revenue.
A system running effectively prevents denials of claims and maintains a visible, efficient billing process. RCM also encompasses everything from determining patient insurance eligibility and collecting co-pays to properly coding claims using ICD-10.

1. There are three stages of the revenue management life cycle. These include the front-end process, the middle process and the back-end process.

During the front-end stage of the cycle you will see “payer negotiation that happens outside the patient encounter, the patient access component that includes scheduling of the patient for inpatient or outpatient services, registration, insurance verification, obtain a prior authorization or a precertification if necessary, and patient financial counseling".

The middle process is where you will see charge capture, case management, clinical documentation, hard coding and soft coding.

The back-end process includes “processing bills, posting payments, correcting any claims that were denied for errors, appeal any denials that are incorrect,supply additional documentation when needed, and make corrections to the charge description master if needed”