HIM1103 mmodule 5 revenue cycle benchmark feb 2024 100%

.docx

School

Rasmussen College *

*We aren’t endorsed by this school

Course

1103

Subject

Industrial Engineering

Date

Apr 3, 2024

Type

docx

Pages

Uploaded by lanakane123

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? 1. Insufficient information- wrong address, wrong DOB, etc. 2. Outdated CPT or ICD10 codes- using codes that don’t exist or are not up to date. 3. Out of network- using doctors that are not “in-network” 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? 1. If the medical records are completed in time. 2. Make sure all the medical instructions and applications are put in place. 3. Make sure patient has the right medications.

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? 1. Attention to detail- Being able to catch mistakes and correct them effectively. 2. Logic- Writing the code should be accurate and simple. 3. Abstract thinking- Must know how to solve problems.

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help