Bryant's Hospital Revenue Cycle Process

allowed to bill for any portion of the costs related to the hospital acquired infection including

Collection agency transaction – Once it has been turned over to a collection agency, the healthcare facility can make no further attempts to collect payment.

Once the patient comes through the door payment for services should be top of mind. All copayments and deductibles collected and any other non-covered expenses billable to the patient. The correct information is gathered and if all is handled initially properly within in the cycle the claim can go the workflow and payment received with minimum effort by human hands.

Accelerating cash collections at the point of service has never been more critical than it is today. Sophisticated accounting tools that enable providers to analyze patient utilization and outcomes help practice managers monitor payer performance and evaluate external contracts effectively. Growing financial pressure to strive toward more efficient claims flow through the revenue cycle means every provider must search for innovative tools to overcome the challenges.

(2) Patient admitted to emergency room via the county jail. The emergency room visit was billed to the jail.

When it comes to the “incident of billing,” the Commission decided to consider that services rendered by clinicians who are not physicians but billed as “incident to” must be paid 100% of the physician fee schedule. The Commission stated that the incident care fee is predicated upon the care or service provided by the team, with the non-physician giving the direct patient care services and the physician taking responsibility to the overall welfare of the patient. They concluded that the team approach

Molly needs to gather information why these accounts are discharged and they are not billed yet. Some of the possible reasons why bills sat there for so long after patient are discharged include the following;

“The Tax Equity and Fiscal Responsibility Act (TEFRA), signed into law September 3, 1982, mandated the development of a prospective payment methodology for Medicare reimbursement to hospitals.” http://sunlightfoundation.com/blog/2009/09/08/slug/. It changed Medicare reimbursement from a fee for service to prospective payment system. Which is where there`s a reimbursement method where`s there an amount of payment determined in advance of services being performed. The rates are done annually. Reimbursements for inpatient care by a classification scheme called diagnosis-related groups. If the patient might have to stay longer in inpatient care more than average days, the hospital may lose money on that patient.

The CMS reimbursement rules for never events cause serious revenue loss for the hospitals, hence a shift in the patient care delivery model in inpatient facilities is required. The goal of this rule is to motivate hospitals to accelerate improvement

I agree with the statement that the patient could be wrongly charged. The insurance company is also likely to deny

The secondary issues are harassment, fraudulent practices, patient endangerment, and decrease in revenue due to penalties and lawsuits. If the patients can prove that the hospital violated HIPPA laws, then the government can impose fines. Hospitals are fined when HIPPA laws are violated (Johnson & Weinstock, 2012). Therefore the hospital may lose revenues through fines and lawsuits. Patient can also sue if investigation proves violation of HIPPA. Also, the debt collectors are too aggressive, which some may view as harassment measures for bill payment. The patients are offered

There is a lack of ownership between Utilization Management and Revenue Cycle to ensure these short inpatient stays are billed correctly.

Medicaid will paid for the remaining balance that the primary insurance don't cover if that balance is part of the charge fee. Usually patient paid at front for they copay if they want to paid us and we go to submit the claim to the patient 2ndry insurance with copy of the primary payment EOB and Medicaid will paid us the rest of the balance of the patient charge fee visit without passing over the Medicaid encounter rate fee. Sometimes Medicaid paid in full and we have to refund to the patient the copayment that the patient paid from the primary payer but this is hard to know because is depending of the patient coverage with the primary insurance.

patient is no longer able to attend a hospital that meets their needs, the lives of the individual’s

If the patient is using a credit card payment is also deducted immediately and would be declined if the patient 's account has no funds. If the physician received a personal check and the patient had insufficient funds in the checking account, the physician would not know this until the check bounced.