Question

. When it comes to supporting an effective and efficient revenue cycle, some desired system capabilities are:

Patient Demographics and Insurance Capture – This step is the starting point of “front-end” processing. Staff must be alert to potential red flags that can result in identity theft.

Eligibility and Benefits Verification – Before patients are scheduled to be seen, their insurance coverage must be verified.

Co-pay Collection – Collection costs increase when co-pays are not paid upfront.

Patient Financial Counseling – Available to patients who are unable to make their co-pay or at risk for not paying their balance after insurance.

Case Management – A collection of services including utilization management, discharge planning, and care coordination performed by a case manager.

What else can be add it to this

need to add more information

Answer 1

Other methods that can be employed for supporting an effective and efficient revenue cycle for a health care organisation are:

1. Educating the staff : Staffs needs to be educated how to add informations in a proper manner in the claims, that are generated from any departments of the hospital in the revenue cycle like billing, collections or scheduling. It is very important to make sure that the accounts are up-to-date and precise and bills are right before being sent to insurance companies.

2. Following techniques of centralised scheduling: It helps to forsee the appointments on a particular date and can determine the number of staffs required then. Also it helps the client to be certain about the payment they need to do after consultation.It also helps in pre-registration that allows a smooth check in - consult - pay - exit process.

3.Standardisation of care: an organisation with a team of highly qualified staffs with excellent professional skills will certainly eliminate the risks for errors and add on to the income by high level patient satisfaction.

4. Proper denial management system: When a clients insurance claim is denied,there should be an effective system to make the necessary changes and submit the claim again, that may include correcting the coding errors, reviewing the submitted client's data for errors and working with the insurance company and client directly.

5.Follow up on patient collections: If the patient receives services that are not covered by the insurance,they need to be informed priorly and proper follow up needs to be done until the due is been paid. Or else implement point-of-service or pre-service payment options that can cancel delay in payments.

6. Ensuring a strong finacial foundation: the competition in the field of health care is high and innovations too are occuring at a rapid rate. Health care organizations should ensure that they have a strong financial basis to cope up with changing trends and newer methods introduced in delivering of health care services.

7.Set goals and monitor performance: setting goals for financial achievements for a time period and close monitoring of flaws and gains help in rectifying the errors and improving the performance and inturn result in increased revenue.