The financial health of the health care organization depends upon its ability to generate consistent and recurring funds from the services it provides. Collectively referred to as the revenue cycle (RCM), critical stages in this process include:
Patient registration.
Collection of demographics and payor source.
Rendering services.
Documenting services.
Establishing charges.
Preparing the claim or bill.
Submitting the claim.
Receiving payment.
Managing accounts receivable.
Decreasing payment delays and lost revenues is a point of interest for many health care managers tasked with oversight of the RCM process. Innovative approaches in technology have assisted with streamlining the RCM process and allowed for automation of many processes, resulting in expedited processing and quick remittance.
Managed care dollars represent a significant portion of all health care organizations’ reimbursements. As a result, health care organizations seek to establish contracts with large managed care organizations (MCOs). Negotiating and securing contracts with MCOs is important for several reasons, including preserving revenues, enhancing patient satisfaction, and generating additional sources of revenue.
All contracts will contain language outlining the administration of the contract along with the payment schedule. While the payment schedule may be seen as the most important element, the terms outlined within the contract are equally as vital to the financial success of the organization.
This assessment focuses on the revenue cycle and how technological innovations have impacted reimbursement for health care organizations. You will take on the role of a patient access supervisor. One of your job functions entails educating new hires about the revenue cycle process.
Instructions
For this assessment, prepare a 10-slide (excluding Title and Reference slides) PowerPoint presentation, with Speaker Notes, outlining the various steps of the revenue cycle. Use the Revenue Cycle Process Template [PPTX] Download Revenue Cycle Process Template [PPTX]to help you structure your presentation.
For the scenario, imagine you are a patient access supervisor who must educate a group of new hires about the revenue cycle process, including:
The revenue cycle process.
Their potential responsibilities.
Why the process is important to a care organization.
Challenges that they may face in their work.
When structuring your presentation, consider the following points and questions to ensure that you are meeting the following scoring guide criteria:
Describe the purpose of each step in the revenue cycle process.
“Describe” means to give an account in words of (someone or something), including all the relevant characteristics, qualities, or events.
The steps within the revenue cycle process include admissions, case management, documentation, coding, billing, and other steps.
Describe key responsibilities of individuals who work in the revenue cycle process.
Describe key components (such as verifying insurance, financial counseling, coding of documented services provided, and other components) and who is responsible (individuals such as coders, registration clerks, and others).
Describe the consequences to the organization of failing to fulfill key responsibilities in the revenue cycle process.
Describe additional steps and challenges in the revenue cycle process when working with an uninsured patient.
Provide information for the new staff regarding options available for the uninsured.
Identify any additional steps throughout the revenue cycle one must be aware of when working with an uninsured patient.
Identify the challenges that exist for the revenue cycle due to the delivery of uncompensated care.
Adhere to the rules of grammar, usage, and mechanics.
“Grammar” refers to the basic rules for how sentences are constructed and how words combine to make sentences (for example, word order, case, and tense).
“Usage” refers to correct word choice and phrasing, particularly with regard to the meanings of words and phrases.
“Mechanics” refers to correct use of capitalization, punctuation, and spelling.
With the exception of the title slide and the reference slide, each slide should contain detailed speaking notes.
Apply APA formatting to in-text citations and references.
Provide in-text citations within the speaking notes, just like you would in a paper, to show where the information was obtained.
Be sure to include an APA-formatted Reference slide at the end of the presentation.
Media presentation: Use the Revenue Cycle Process Template [PPTX] Download Revenue Cycle Process Template [PPTX]provided.
Create 10 slides (excluding Title and Reference slides) that you could present in 10–20 minutes.
3–5 bullet points per slide; 5–7 words per bullet point.
Resources: Cite at least three scholarly resources, as researched in this assessment’s studies.
Your textbook can be one of the three.
APA guidelines: Use APA style for references and citations. When appropriate, use APA-formatted headings. For more information, refer to Evidence and APA.
Slide font and font size: Times New Roman, using appropriate size and weight for a presentation, generally 24–28 points for headings and no smaller than 18 points for bullet-point text.
Speaker Notes: Font size no larger than 12 point, single-spaced, indented paragraphs; include in-text citations in Speaker Notes.
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:
Competency 3: Explain the organizational revenue cycle process.
Describe the purpose of each step in the revenue cycle process.
Describe key responsibilities of individuals who work in the revenue cycle process.
Describe the consequences to the organization of failing to fulfill key responsibilities in the revenue cycle process.
Describe additional steps and challenges in the revenue cycle process when working with an uninsured patient.
Competency 4: Communicate in a manner that is scholarly, professional, and respectful of the diversity, dignity, and integrity of others and is consistent with the expectations of health care professionals.
Adhere to the rules of grammar, usage, and mechanics.
Apply APA formatting to in-text citations and references.
