Revenue Cycle Management In Health Care

Two organizations migrating to a common health information system would need a system that meets current regulatory requirements, meets the needs of the combined organization and their practice environment. The implementation of a common health information system would require an interdisciplinary group of forward thinking innovators, and an interoperable electronic medical record system that includes standard nursing terminology.

The introduction of information systems in health care industry has made enormous development in patient care and satisfaction. The interoperability of the different systems with in a organization is important to achieve effectiveness of the system. The process of developing and integrating the information system is time consuming, complex and costly. This paper is a report submitted by an informatics director to the chief operating officer of an organization proposing a solution to solve the communication problems within the information system.

Revenue cycle management (RCM) has become increasingly complex thanks in large part to the almost-constant health care reforms and initiatives. As ICD-10 is about to become the new coding standard, hospitals and private practices have begun arming themselves with as many tools and techniques as they can that will help them better manage their revenue cycles.

Managers who are managing health care organizations must be attentive to the accounting practices and must obey and practice the financial management procedures to be able to solve any issues if any should arise. With the continuation of the high costs of health care managers as well as consumers must know how to budget carefully. According to All Business. (2010), the cost of providing health care services, patients way of payment for these services and the environment in which those patients reside and receive those services are important elements that affect the care this is or may not be

In the medical billing revenue cycle, there are ten steps. The first step is patient preregistration where a patient schedules a visit and their insurance is either verified or on file. The second step is to determine the patient’s payment when visiting the provider and the reason for their visit. Next is to check the patient in upon arrival at their visit. This is to verify the insurance and the identity of the patient. The patient is checked out after seeing the provider and charges for services will show on the superbill. After this, the medical biller takes the patient’s superbill and creates a claim. From here, the biller must ensure that the claim is compliant with coding and arrangement. From here, the claim is prepared and finally

It has only been within the last five years that health information management (HIM) has experienced exponential changes, due to the healthcare reform. The electronic health record (EHR) is connected to health information exchanges and other systems of interoperability. The timely completion of charts, coding and release of information (ROI) has become much more efficient with the electronic record. Traditional HIM functions will just be transformed and will always be an integral part of successful patient care. Professionals must be flexible and willing to adapt and even generate change. As Health Information Technology continues to evolve, so will the roles

In the health care world finances play a significant role in the quality of care rendered to the consumer. There is no health care facility that is the same when it comes to their financial management because it is needed both internally and externally to ensure that it runs properly. Today’s health care field consist of either not-for-profit organizations, for-profit organizations and governmental, (Gapenski, 2008).

team due to its impact on both patient quality and employee productivity. Another plan developed by the QI team that required an immense analysis of it’s cost-benefit-quality balance is the implementation of the Electronic Health Records across all facilities and departments of the hospital. The cost to implement such a powerful system that can improve the productivity of the entire hospital is enormous. However, it’s ability to streamline information across all departments and facilities within the hospital provides a lot of benefits that will eventually increase the quality of care delivered to patients and the productivity of employees. A reduction in silos among

“Attention should be given to assessing the impact of new methods of organizing the delivery of health care services, adoption of electronic information systems, and health reform provisions that will test and reward health care organizations that are accountable for achieving better outcomes, higher quality, and lower costs” (Davis, 2012). Only collaboration between payers and physicians, with a focus on improving the health outcomes of patients will bend the projected cost curve set forth.

We recently finished a campaign to save $10,000,000. My current responsibilities include another campaign to save additional $20,000,000 for 2016 and a program to increase Utilization Management (UM). Our goals for the UM is to balance patient care, risk, and cost across the organization. It is an interdisciplinary and cross functional approach. I am leading a team to empower the c-level executives, hospital administrations, and medical professionals to effectively

S healthcare system vulnerable to more spending if effective precautionary or cost control measures are not introduced or implemented. Furthermore, the introduction of value-based- payment that is focused towards patient-centered system has induced many non-profit organizations to shift towards patient’s satisfaction. These new developments in healthcare drive my decision in not-for-profit healthcare administration. As a prospective healthcare leader, one of my career aims is to become an active healthcare service advocate dedicated towards public health supplies management, health service waste reduction, and supply allocation. Not-for-profit healthcare administration is essential in today’s healthcare environment. Unlike for-profit healthcare organizations, not-for-profit organizations have no stockholders, and they reinvest the profits into the organization to offer more quality healthcare services at an affordable cost. Healthcare cost is rising as high deductible health plans enter the health insurance marketplace while wages or living conditions stay the same. As a former ACA Health Exchange Navigator, I experienced the impact of high-deductible health plans on individuals and family who cannot afford health insurance due to financial

In 1986, IHC begin to implement a new strategy for managing healthcare. This new clinical integration focused on improving patient care while saving money. This idea was implemented by changing the organizational structure of certain clinics and providing them with helpful tools. The Traditional administrative management was upgraded to a system that involved the storage of all patients’ data to create helpful tools. The tools that were implemented created protocols that helped medical providers determine the best method of intervention while increasing efficiency.

The accounts receivable is on part of the revenue cycle within a healthcare organization. Accounts receivable is defined as the revenue that patients and third parties owe the organization for services that have been provided (Nowicki, 2015). Obtaining demographic information, insurance data, verifying insurance coverage, acquiring deductibles and copayments, receiving authorizations, recording charges, printing and submitting bills, following up with patients about payment, and collecting payment are some of the activities within the accounts receivable cycle (Nowicki, 2015). The revenue cycle utilizes a multidisciplinary system to decrease amounts within accounts receivable by managing the payment cycles (Nowicki, 2015). Some of the management

The Accountable Care Organization and Patient Centered Medical Home case studies both did best to implement pilot programs, models and experiments that will essentially coordinate at the same time integrate healthcare goals with the healthcare system aimed at improving patient outcome and lowering costs for quality service. PCMH also did best in making sure patients had constant access to their providers at the same time provide care that was team based by coordinating care with various providers at the same time assure the quality and safety of each patient. As for ACO they did best in their improvement of care and lowering cost by coordinating with physicians and institution that are providing care to Medicare beneficiaries. Their ultimate goal is improving the quality and value of health care services at the same time control costs while improving the delivery of healthcare by measuring quality and satisfaction as defined in Shi and Singh (2015) Donabedian Model which can be achieved by establishing structure, process and outcome (p. 494). In the end ACO and PCMH focused their attention in preserving wellness, disease prevention, and treating illness by assuring that each patient received the best care possible from their health care providers.

The evidence presented shows an urgent need in the user-friendly technology design with a swift accessibility to all healthcare networks with no nonsense standardized clinical information system. While the digital technology is adapted by most healthcare facilities, the difference in the programs makes it nearly impossible to effectively communicate electronically. Nevertheless, the continued objective of healthcare is to improve healthcare delivery, including reduction of unnecessary tests and procedures and decreasing the overall