Module05AssignmentWorksheet

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Rasmussen College, Florida *

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1103

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Industrial Engineering

Date

Dec 6, 2023

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docx

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2

Uploaded by DrNeutron10657

Module 05 Assignment - Revenue Cycle Benchmarks Overview: In this assignment, you must recognize the importance of performance benchmarks in a high- performing revenue cycle and determine underlying factors that need to be addressed to ensure successful outcomes. Instructions: Read each scenario, research the benchmark of concern, and then answer the scenario’s question. Be sure to write your answer beneath each question, using complete sentences, reflecting proper spelling and grammar. Scenario 1: Denials The Chief Financial Officer (CFO) has expressed a concern with the increasing number of denials. A team consisting of individuals from Admissions, Utilization Management, CDI, Coding and Billing have been assigned the task of studying the denials to determine some action steps to improve the process. The KPI for denials is 4%, however, the current rate is 10%. The CFO wants to see a drop in the rate to 8% within the next 6 months and another reduction to 6% within the year. Tips: Consider why the CFO chose these departments to participate on this team. Think about their roles and responsibilities that could be a factor if the task is not being performed effectively or at all. Research effective management of denials. Question: What are 3 possible causes for denials from these areas? The three possible causes for denials from these areas are 1) the admissions team. They do not overcheck the eligibility of patients and they also do not take down sufficient information that is needed. 2) Billing and coding. It is possible that there might be duplicate billing and improper CPT or ICD 10 codes encoded. 3)Utilization management. They don’t evaluate the efficiency , what’s appropriate as well as medical necessity of the treatment, services, procedures and facilities that are provided on a case by case basis Scenario 2: Delinquent Records The Health Information Manager is concerned about the increasing number of delinquent records. The KPI for delinquent record completion is within 20 days of discharge. Currently, the average number of days for record completion is 45 days. Tips: Consider some steps the HI Manager can take to identify the underlying factors impacting the number of delinquent records. Think about provider practices in regard to record completion. Research effective management of delinquent records. Question: What information will she need to know in order to obtain assistance from the Chief Medical Officer to reduce the number of delinquent records?
The HIM will need to understand how to apply hospital specific regulations and procedures. They will also need to understand how to use to proper resources and will require clinical knowledge. Scenario 3: Coding Quality The Coding Manager is tasked with creating a coding quality plan. She is researching coding quality initiatives in an attempt to determine her next steps in developing an effective plan. The KPI for coding quality is 98%. The coders are currently averaging 90% accuracy. Tips: Consider what some impacts to coding quality that would need to be considered based on what you have learned in this course about accurate coding relative to knowledge and skills to be a good coder. Research coding quality plans. Question: What are 3 items that need to be addressed in the coding quality plan that will help achieve the KPI of 98% accuracy? Three items that need to be addressed in the coding quality plan that will help achieve the KPI of 98% accuracy is detailed documents, proper training and better Communication. Also evaluation and updates for continuous improvement.
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