In: Operations Management
You have been recently hired at UMGC Health. One of your new job functions entails educating new hires on the revenue cycle process. For this assignment, you will prepare a 3-5 page white paper outlining the basic steps of the revenue cycle.
Identify the various steps within the revenue cycle process, including admissions, case management, documentation, coding, billing, et cetera. For each step identified, provide details pertaining to the following: Purpose of the step identified. The individuals involved in the process (e.g., providers, transcriptionists, coders, registration clerk, etc.). The key components of the function, such as verifying insurance, financial counseling, coding of documented services provided etc. The consequences of failure to properly conduct the function identified.
· Note: outside research beyond the textbook is required for this assignment. Support your research with at least five sources. The use of professional charts / graphs to reinforce written content is encouraged.
EXPLANATION:
It is important to understand in the first place, according to the assignment, the concept of the revenue cycle; then each cycle, from the first to the last process, can be understood and key elements, components and participants can be mentioned. Note also that these step processes include customer registration, insurance verification, collection of the deductible, review and processing, filing claims, claim management, payment collections and last reporting. The process includes the scheme and registration of customers.
This is essentially the simple admission in the first phase of scheduling and registration, which is intended to open the process and the information of clients are inserted into the system. Participants are patients or data entry clients, among others receptionists. The key components are identity verification, and there is an identity problem causing misprescription if done incorrectly.
The second step is a review of insurance that includes the insurance provider, patient or client, the insurance firm, whether the client or patient is insured. The key components include the verification of the insurance system and the submission of insurance documents, but the patient will not move to the next level or be fully charged if this fails properly.
In the third step, the payment is made of services like registration, which means that patients or clients can move to the next stage of examination, including patients, finance officers, whereas the main elements include payment issue, payment receipts or services and if they fail to do so, the result is that there is no attendance at all.
The fourth step is to examine and treat the real problem and how to help the customer. Participants can include patients or clients, nursing doctors, laboratory technicians and drugstores. Body testing, laboratory tests, care management, diagnosis and more are the main components. If this is not done correctly, it can lead among other related effects to misdiagnosis, false dose, death and deterioration.
In the fifth step, if the claim is presented, payments will be submitted to the insurance company for compensation. This step involves checking services rendered by the health service provider, issuance, inter alia, of payments, failure to perform this correctly causes consumers or patients liability and is not paid. The main components of this process include checks on the services offered by the healthcare provider.
In the sixth step, claims are managed to ensure that all claims are carefully considered and answered, that the most important parties can include insurance company management, and verification and the processing of the claim to the client are again important components.
In the seventh stage, the insurance company collects the customer for payment, the purpose being to fulfill its compensation and this includes the customer and the management of the insurance company, whereas key components may include collection, signature and checks, or the customer misses compensation if not well done and is postponed for another day.
In the eightth step, reporting is the main activity, which is also made in a great many reconciliations to keep the income cycle going. The objective is to provide the insurance company with their own internal reports to different departments. The reporting system is responsible. Components are surrenders, filing reports, etc. Failure to do so would affect the income cycle as a result of breakdown.
This deep definition of the sales cycle should be understood. It should also be noted how crucial it is to sustain the flow of resources and ensure time is well handled and well used. It also guarantees customer service in a way that offers an essential and very realistic structure or a cost to businesses and organizations when it comes to the efficient use of resources. This also provides the justification of the above measures and processes to achieve the entire revenue cycle term.
Reference
Everything You Need to Know About Revenue Cycle Management by revenue cycle solutions