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Gave a description of background all ready and one classmate need to add one more next week  

Give a brief overview of your educational background and experience in healthcare or other business. Share a personal experience dealing with healthcare reimbursement and any inefficiencies with the process. How does reimbursement tie into the revenue cycle?

In response to your peers, support the points they made around what seems to be working and what needs improvements with one additional idea.

Discussion: Getting Started and Reimbursement Inefficiencies

Give a brief overview of your educational background and experience in healthcare or other business. Share a personal experience dealing with healthcare reimbursement and any inefficiencies with the process. How does reimbursement tie into the revenue cycle?

Hello Everyone,

My name is Tammy and I live in AZ. with my husband and two wonderful boys. I was born and raised in CA. and moved around because my husband was in the Army who is now a retired veteran with PTSD. I have been with SNHU since 2018 and working towards my BS in Healthcare Administration w/ Concentration in Health Information Management. I currently have my pharmacology degree and graduated in 2014, I worked for my pharmacology degree because my son was diagnosed with Autism when he was five years old.

In response to your peers, support the points they made around what seems to be working and what needs improvements with one additional idea.

Classmate # 1

Daniel Kovacs posted Aug 20, 2020 9:32 AM

Hi All,

Considering this, a personal experience I can relate to is a business I am in the process of starting and also as an investor. After reading the texts this week, I connected with the details associated with accounting authorities. First, regarding financial organizations, I am a corporation owner. The reason I chose this approach is because of inefficiencies surrounding the revenue cycle within the commonwealth of Massachusetts for sole-proprietor and partnerships. In particular, the way payments flow between employees and the corporation’s master account has strict taxation regulations. More specifically, sole proprietorships are too risky as it does not allow the owner to maintain the legal protections that a corporation has in the event litigations arise, and payments of employees needs to be conducted with a meticulous analysis for taxation pitfalls. There are some valid parallels between this limitation and the strict regulation of the revenue cycle that confront the Californian hospitals as illuminated in the 2008 article from the Journal of Healthcare Management. For example, one issue that the hospitals found was that “the speed with which accounts receivable are converted into cash has important implications” for a given hospital that impact the magnitude of profitability since this directly affects “the ability to build equity to ensure the hospital’s long-term financial viability” (Rauscher, Wheeler, & Hilleary, 2008). Therefore, I can relate to this as if I cannot receive payments timely for my business, it can negatively impact the way I structure my assets and the financial flexibility that I will be able to use for further profit maximization through spending these funds on marketing campaigns. Since the service I provide is a package, this portion of the Revenue Cycle Management (RCM), is a front-end process because depending on the service selected I will need to ensure contract management to allow for timely payment of service to avoid falling into the silo “fragmented approached” which dictates the effectiveness that is “recently related to the overall financial stability” of my business (Harrington, 2020).

As an investor, it is also important to understand several variables of the revenue cycle. Before purchasing an asset, I like to ensure that the organization I am keen to support is following the guidance of accounting authorities. Typically, the policies set forth by the Securities and Exchange Commission build my consumer confidence as I look at them as the stock market police. Since they strive to ensure investors “have access to basic facts about a particular investment or multiple investments through the disclosure of meaningful, timely, and accurate information,” I feel more protected that a business will follow the rules to reduce volatility (Harrington, 2020). Given this, revenue cycle comes into focus as quarterly reports are required to be provided to consumers, voting rights on important issues are regulated, and enforcement around violations is ensured. This crosses over greatly into how healthcare administrators can look at the reimbursement cycle and detect any inefficiencies as being able to analyze this data, understand any important regulations, and maintain the knowledge about how to conduct lawful transactions will increase the mission and vision of any organization as the public will have more trust in their values and their profitability will most likely advance their growth in the infamous competitive healthcare marketplace.

Discussion: Getting Started and Reimbursement Inefficiencies

Give a brief overview of your educational background and experience in healthcare or other business. Share a personal experience dealing with healthcare reimbursement and any inefficiencies with the process. How does reimbursement tie into the revenue cycle?

Hello Everyone,

My name is Tammy and I live in AZ. with my husband and two wonderful boys. I was born and raised in CA. and moved around because my husband was in the Army who is now a retired veteran with PTSD. I have been with SNHU since 2018 and working towards my BS in Healthcare Administration w/ Concentration in Health Information Management. I currently have my pharmacology degree and graduated in 2014, I worked for my pharmacology degree because my son was diagnosed with Autism when he was five years old.

In response to your peers, support the points they made around what seems to be working and what needs improvements with one additional idea.

Classmate # 1

Daniel Kovacs posted Aug 20, 2020 9:32 AM

Hi All,

Considering this, a personal experience I can relate to is a business I am in the process of starting and also as an investor. After reading the texts this week, I connected with the details associated with accounting authorities. First, regarding financial organizations, I am a corporation owner. The reason I chose this approach is because of inefficiencies surrounding the revenue cycle within the commonwealth of Massachusetts for sole-proprietor and partnerships. In particular, the way payments flow between employees and the corporation’s master account has strict taxation regulations. More specifically, sole proprietorships are too risky as it does not allow the owner to maintain the legal protections that a corporation has in the event litigations arise, and payments of employees needs to be conducted with a meticulous analysis for taxation pitfalls. There are some valid parallels between this limitation and the strict regulation of the revenue cycle that confront the Californian hospitals as illuminated in the 2008 article from the Journal of Healthcare Management. For example, one issue that the hospitals found was that “the speed with which accounts receivable are converted into cash has important implications” for a given hospital that impact the magnitude of profitability since this directly affects “the ability to build equity to ensure the hospital’s long-term financial viability” (Rauscher, Wheeler, & Hilleary, 2008). Therefore, I can relate to this as if I cannot receive payments timely for my business, it can negatively impact the way I structure my assets and the financial flexibility that I will be able to use for further profit maximization through spending these funds on marketing campaigns. Since the service I provide is a package, this portion of the Revenue Cycle Management (RCM), is a front-end process because depending on the service selected I will need to ensure contract management to allow for timely payment of service to avoid falling into the silo “fragmented approached” which dictates the effectiveness that is “recently related to the overall financial stability” of my business (Harrington, 2020).

As an investor, it is also important to understand several variables of the revenue cycle. Before purchasing an asset, I like to ensure that the organization I am keen to support is following the guidance of accounting authorities. Typically, the policies set forth by the Securities and Exchange Commission build my consumer confidence as I look at them as the stock market police. Since they strive to ensure investors “have access to basic facts about a particular investment or multiple investments through the disclosure of meaningful, timely, and accurate information,” I feel more protected that a business will follow the rules to reduce volatility (Harrington, 2020). Given this, revenue cycle comes into focus as quarterly reports are required to be provided to consumers, voting rights on important issues are regulated, and enforcement around violations is ensured. This crosses over greatly into how healthcare administrators can look at the reimbursement cycle and detect any inefficiencies as being able to analyze this data, understand any important regulations, and maintain the knowledge about how to conduct lawful transactions will increase the mission and vision of any organization as the public will have more trust in their values and their profitability will most likely advance their growth in the infamous competitive healthcare marketplace.

Discussion: Getting Started and Reimbursement Inefficiencies

Give a brief overview of your educational background and experience in healthcare or other business. Share a personal experience dealing with healthcare reimbursement and any inefficiencies with the process. How does reimbursement tie into the revenue cycle?

Hello Everyone,

My name is Tammy and I live in AZ. with my husband and two wonderful boys. I was born and raised in CA. and moved around because my husband was in the Army who is now a retired veteran with PTSD. I have been with SNHU since 2018 and working towards my BS in Healthcare Administration w/ Concentration in Health Information Management. I currently have my pharmacology degree and graduated in 2014, I worked for my pharmacology degree because my son was diagnosed with Autism when he was five years old.

In response to your peers, support the points they made around what seems to be working and what needs improvements with one additional idea.

Classmate # 1

Daniel Kovacs posted Aug 20, 2020 9:32 AM

Hi All,

Considering this, a personal experience I can relate to is a business I am in the process of starting and also as an investor. After reading the texts this week, I connected with the details associated with accounting authorities. First, regarding financial organizations, I am a corporation owner. The reason I chose this approach is because of inefficiencies surrounding the revenue cycle within the commonwealth of Massachusetts for sole-proprietor and partnerships. In particular, the way payments flow between employees and the corporation’s master account has strict taxation regulations. More specifically, sole proprietorships are too risky as it does not allow the owner to maintain the legal protections that a corporation has in the event litigations arise, and payments of employees needs to be conducted with a meticulous analysis for taxation pitfalls. There are some valid parallels between this limitation and the strict regulation of the revenue cycle that confront the Californian hospitals as illuminated in the 2008 article from the Journal of Healthcare Management. For example, one issue that the hospitals found was that “the speed with which accounts receivable are converted into cash has important implications” for a given hospital that impact the magnitude of profitability since this directly affects “the ability to build equity to ensure the hospital’s long-term financial viability” (Rauscher, Wheeler, & Hilleary, 2008). Therefore, I can relate to this as if I cannot receive payments timely for my business, it can negatively impact the way I structure my assets and the financial flexibility that I will be able to use for further profit maximization through spending these funds on marketing campaigns. Since the service I provide is a package, this portion of the Revenue Cycle Management (RCM), is a front-end process because depending on the service selected I will need to ensure contract management to allow for timely payment of service to avoid falling into the silo “fragmented approached” which dictates the effectiveness that is “recently related to the overall financial stability” of my business (Harrington, 2020).

As an investor, it is also important to understand several variables of the revenue cycle. Before purchasing an asset, I like to ensure that the organization I am keen to support is following the guidance of accounting authorities. Typically, the policies set forth by the Securities and Exchange Commission build my consumer confidence as I look at them as the stock market police. Since they strive to ensure investors “have access to basic facts about a particular investment or multiple investments through the disclosure of meaningful, timely, and accurate information,” I feel more protected that a business will follow the rules to reduce volatility (Harrington, 2020). Given this, revenue cycle comes into focus as quarterly reports are required to be provided to consumers, voting rights on important issues are regulated, and enforcement around violations is ensured. This crosses over greatly into how healthcare administrators can look at the reimbursement cycle and detect any inefficiencies as being able to analyze this data, understand any important regulations, and maintain the knowledge about how to conduct lawful transactions will increase the mission and vision of any organization as the public will have more trust in their values and their profitability will most likely advance their growth in the infamous competitive healthcare marketplace.

Classmate # 2

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Effective Hospital Revenue Cycle Management: Is There a Trade-off … Rauscher, Simone, MA;Wheeler, John R C, PhD;Hilleary, Gwenmarie, FACHE Journal of Healthcare Management; Nov/Dec 2008; 53, 6; ProQuest Central pg. 392

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HFMA

Revenue Cycle

Revenue Cycle Functions

Fundamental functions: Ø Data collection Ø Charge capture Ø A/R posting Ø Collections/reimbursement

Revenue Cycle Functions

Data collection Ø Access

-  Adequate and correct patient information -  Example of complete information: Name and

other identifiers such as sex, date of birth, race, social security number, and marital status…

Revenue Cycle Functions

Data collection Ø Access

-  Accurate information: Key information should be verified

HIM & Medical Record

Revenue Cycle Function

Data Collection Charge Capture in Charge Master

Patient Financial Services

Revenue Cycle Functions

PFS: Ø Gather charges for services provided Ø Assemble charge in proper format on the

claim Ø Submit timely claims to payors Ø Collect balances due and manage AR

Revenue Cycle Function

Pre- In- Discharged Bed admission Admission house Discharge (not final billed) request

Billed Account Account Bill print A/R Bill submit follow-up collection

Account $ Payment resolution

Revenue Cycle Practicum

Undergraduate Discussion Rubric

Overview

Your active participation in the discussions is essential to your overall success this term. Discussion questions will help you make meaningful connections between the course content and the larger concepts of the course. These discussions give you a chance to express your own thoughts, ask questions, and gain insight from your peers and instructor.

Directions

For each discussion, you must create one initial post and follow up with at least two response posts. For your initial post, do the following:

 Write a post of 1 to 2 paragraphs.

 In Module One, complete your initial post by Thursday at 11:59 p.m. Eastern.

 In Modules Two through Eight, complete your initial post by Thursday at 11:59 p.m. of your local time zone.

 Consider content from other parts of the course where appropriate. Use proper citation methods for your discipline when referencing scholarly or popular sources.

For your response posts, do the following:

 Reply to at least two classmates outside of your own initial post thread.

 In Module One, complete your two response posts by Sunday at 11:59 p.m. Eastern.

 In Modules Two through Eight, complete your two response posts by Sunday at 11:59 p.m. of your local time zone.

 Demonstrate more depth and thought than saying things like “I agree” or “You are wrong.” Guidance is provided for you in the discussion prompt.

Rubric

Critical Elements Exemplary Proficient Needs Improvement Not Evident Value

Comprehension Develops an initial post with an organized, clear point of view or idea using rich and significant detail (100%)

Develops an initial post with a point of view or idea using adequate organization and detail (85%)

Develops an initial post with a point of view or idea but with some gaps in organization and detail (55%)

Does not develop an initial post with an organized point of view or idea (0%)

40

Timeliness N/A Submits initial post on time (100%)

Submits initial post one day late (55%)

Submits initial post two or more days late (0%)

10

Engagement Provides relevant and meaningful response posts with clarifying explanation and detail (100%)

Provides relevant response posts with some explanation and detail (85%)

Provides somewhat relevant response posts with some explanation and detail (55%)

Provides response posts that are generic with little explanation or detail (0%)

30

Critical Elements Exemplary Proficient Needs Improvement Not Evident Value

Writing (Mechanics)

Writes posts that are easily understood, clear, and concise using proper citation methods where applicable with no errors in citations (100%)

Writes posts that are easily understood using proper citation methods where applicable with few errors in citations (85%)

Writes posts that are understandable using proper citation methods where applicable with a number of errors in citations (55%)

Writes posts that others are not able to understand and does not use proper citation methods where applicable (0%)

20

Total 100%

Module One: Healthcare Finance and

the Revenue Cycle HCM 345

•  This course will explore some of the major issues facing the healthcare industry and the effect that public policy and business environment have on a healthcare organization.

•  The emphasis is on the supply and demand theory, reimbursement systems, managed care, charge-master management, case-mix management, diagnosis-related group (DRG) prospective payment, insurance, Medicare, Medicaid, governmental regulations, accessibility, eligibility, budgeting, and planning.

Course Description

•  To reimburse is to repay someone (Reimburse, 2014). The “someone” in this case is the healthcare organization.

•  The “repayment” for healthcare organizations comes from third-party payers such as insurance companies or the patient.

•  If departments do not follow the guidelines put into place or do not capture the necessary information, it can be detrimental to the reimbursement system.

What Is Reimbursement?

•  There are many variations of the name of the group that focuses on the revenue cycle within a healthcare organization.

•  For this course, the department will be referred to as patient financial services (PFS).

Patient Financial Services

•  Important roles for PFS personnel include the following: –  Monitoring the reimbursement process –  Analyzing the reimbursement process –  Suggesting changes to help maximize the reimbursement

•  One way to make this process more efficient is by ensuring that the various departments and personnel are exposed to the necessary knowledge.

Role of PFS

•  Much of what happens in healthcare is about understanding the expectations of the many departments and personnel within the organization.

•  Reimbursement drives the financial operations of healthcare organizations.

•  Each department affects the reimbursement process regarding timelines and the amount of money put into and taken out of the system.

Departmental Expectations

•  There are numerous regulations found in healthcare. •  Regulations are there to ensure the privacy and integrity of patient

records, provide incentives to providers, and to reduce or eliminate the incidents of fraud and abuse.

•  Regulations will be covered to facilitate the understanding of why and how they are used.

Healthcare Regulations

•  Healthcare costs in the United States are high and are debated often. •  Health reform is a topic of discussion in many of the presidential

elections and continues to be a topic discussed by many individuals. •  The Affordable Care Act (ACA), also known as Obamacare, will be

discussed as one effort to control costs.

Affordable Care Act

•  Healthcare has its own language, as it is full of acronyms. •  Upon completing this course, students will understand the

reimbursement side of healthcare and the acronyms that are frequently used.

•  In addition, students will learn to use informational and research tools to make effective management decisions.

The “Language” of Healthcare

•  The mission of healthcare organizations is to provide quality care to patients.

•  The mission of healthcare finance is to make sure the finances are available to continue providing that quality care.

•  Finances in healthcare pay for salaries of caregivers, diagnostic equipment, and other items required to provide care.

What Is Healthcare Finance?

•  A patient does not usually choose to be a patient. (In other businesses, consumers choose to purchase products or services.)

•  Services are provided in emergency cases before money is collected. (There is no option to repossess the products or services—one cannot put an appendix back in the patient!)

What Makes Healthcare Finance Unique?

•  Financial data is used for financial reporting and decision making. •  Claims processed, but not collected, are reported for follow-up. •  Decisions are made for capital investments. •  Financial data is governed by accounting authorities.

How Is Financial Data Used?

•  The revenue cycle is one of the most important financial processes in healthcare organizations.

•  Information used for reimbursement is gathered throughout the patient encounter.

•  The initial financial information, such as insurance information, is gathered at the point of encounter.

•  Partial payment can also be collected at the initial encounter.

Revenue Cycle

•  Charges for services are captured for services and procedures and added to the patient bill.

•  These charges are processed for payment and are referred to as “claims” processing.

•  A claim is an official request or demand for something believed to be owed to oneself (Claim, 2014).

Revenue Cycle (continued)

•  When the patient accumulates charges for his or her services, the claims are filed to get payment, or reimbursement, for these services.

•  Before the claims can be submitted, codes need to be applied to the patient encounter.

Revenue Cycle (continued)

•  The codes are determined according to guidelines and are decided by the health information management (HIM) personnel who are trained in coding.

•  This course will discuss coding from the perspective of non-HIM professionals.

•  Claims need to be filed promptly in order for payments to be received in a timely manner.

Revenue Cycle (continued)

•  Claims can be denied or paid. There is software to help ensure that the claims are error-free and will be paid promptly. –  If denied, follow-up must happen to refile promptly. –  If paid, the patient is billed for the remaining balance or the balance is written

off according to negotiated terms.

Revenue Cycle (continued)

•  Reimbursements contribute to cash flow for the healthcare organization. Cash is essential for financial operations and sustainability.

•  The revenue cycle continues throughout the patient care, through the discharge, and continues on until the patient billing is brought to a zero balance.

Revenue Cycle (continued)

•  There are various types of payers, including private insurance, managed care organizations, the government, and the patient.

•  They all have different claim-filing guidelines. •  PFS personnel can become experts at filing timely claims with each

payer.

Payers

•  As previously mentioned, a patient does not usually choose to be a patient.

•  A patient comes into the healthcare system with much anxiety. •  The PFS personnel have an opportunity to provide exceptional customer

service, which can relieve some of the anxiety and “make or break” the patient experience.

Customer Service Excellence

•  A friendly face, courtesy, and respect go a long way toward putting a patient at ease.

•  Patients know that their charges may result in a large amount of money owed, and the expense is usually not part of their personal budget.

•  PFS personnel can help them find ways to pay for their services, reducing their stress.

Customer Service Excellence (continued)

•  Module One highlights the following: -  Healthcare finance and what makes it unique from other businesses -  Revenue cycle -  Customer service

•  Module Two will continue the discussion of reimbursement by introducing financial management and coding (from a non-coding professional viewpoint)

Conclusion

Claim. (2014). In Merriam-Webster’s online dictionary. Retrieved from http:// www.merriam-webster.com/dictionary/claim

Reimburse. (2014). In Merriam-Webster’s online dictionary. Retrieved from http:// www.merriam-webster.com/dictionary/reimburse

References