I need 2 different discussion posts for a healthcare financial management class. Please make sure they have a different analyzation and ideas. the deadline is 16-20 hours.
Respond to the following question (minimum 200 words) and provide at least two responses to others.
As with any business,
healthcare providers must deal with the nuts and bolts of getting paid so that
the business can continue to function and serve people. But in healthcare,
revenue cycle management is complicated by several factors, including strict
regulations, an ever-evolving payer mix, and consumers who are dealing with
shouldering more of the cost of their care themselves. Effective healthcare
revenue cycle management is an ongoing process, and healthcare providers that
pay insufficient attention to it can count on facing financial and operational
After watching the video
lectures, review the HFMA website for recent posts regarding the revenue cycle and
discuss your opinion on the major obstacles to good revenue cycle management, what
the near future hold for revenue cycle management, and any other information
you feel pertinent regarding the revenue cycle. Make sure you reference the
HFMA resources used.
REMEBER 2 DIFFERENT POSTS
Patient services are the
heart of the income for healthcare organizations. The revenue cycle is
the circulatory system that incorporates the clinical and administrative
functions to capture and manages patient service revenue. There are
many different components that play important roles in keeping this
system up and running. All
the components need to work together and separately to maintain proper
payment methods, that consider, rules, regulations, and proper charge
capture methods. Services provided need to be paid for and moving the
money though this system can be difficult. The most important thing to
understand is that there is an equal responsibility, between medical
professionals and administration in this process.
This biggest challenge to patients today and moving forward is the knowledge of their role in this system.
I feel that this system is constantly changing and adapting to the
times, changes that are currently taking place are due to the generation
of millennials that are now accessing, healthcare. “Millennials are entering their prime earning (and spending) years and will account for 75 percent of the workforce by 2025.”
There was a delay in this generations’ entrance into the healthcare
system. Since the enactment of the Affordable Care Act, children can
stay on their parent’s insurance up until 26. I can only speak for
myself, but this has delayed my full understanding of how payments for
medical services work. I feel that there is an overall lack of
understanding until it is necessary to pay for healthcare, which is
almost too late.
order to improve this system to cater to millennials, changes need to be
made, in delivery, communication and payment. Technology
has helped update and maintain this system. Electronic review
processes help this system run faster. Technology is also important to
millennials. In the future going completely digital, with this process,
especially for payment will keep this system running. The millennials
entering the workforce will also benefit from this system becoming
electronic. As far as delivery and communication methods, it has been
said that millennials look for personalized communication. Due to the
delay and lack of understanding in this system, there needs to be
personal explanations on how this system works, regarding personal use
and needs. The solution is simple, it is to educate. While the system
is complex and constantly changing, a basic understanding of this system
will benefit the future of revenue cycle management. It has been
reported that, “more than
half of millennials say they don’t know how a high-deductible health
plan works.” The payment is only part of this system, but if proper
payment is not met this system will stop running. Knowledge of this
system is not only important for those who have a future in the field,
it is important for the future of healthcare services.
I currently work as a Revenue Cycle Service Line
Specialist which involves billing and follow up, charge corrections, charge
entry, AR reporting, and various other facets of revenue cycle. This field can be very inefficient and
confusing especially when navigating through various insurance types like
Medicare, Medical Assistance, commercial, managed care, and Blue Shield
products. A major obstacle I find in my
daily workflow is the amount of different resources and tools I have to use
when investigating and working on claims.
According to an HFMA article regarding challenges facing health systems
in terms of payment collection a community hospital in Colorado runs its
revenue cycle management on no fewer than 22 software tools. Only a third of those tools communicate with
each other and staff are forced to toggle between multiple systems. In my workflow I may have to check a patient’s
insurance information in their electronic health record. If I cannot verify it there I have to go out
to a web-based system called Navinet. I
will go back to the EHR to make necessary changes then go into a system called
IDX to check the necessary invoice. If I
have questions about the way the invoice billed out I will use a system called
ePremis. If I need to pull up an
explanation of benefits I may have to use other systems depending on the payer.
So far I am up to five systems for one claim.
This is not even considering the systems used by access reps to take
patient payments or systems or a completely separate system that handles
certain lab charges.
A major issue with
this is not only inefficiency, but the risk of workflow errors that will
interface with other systems and make one error into a domino effect. If a patient’s insurance is loaded with the
incorrect ID number this incorrect ID will flow into multiple systems causing
errors throughout the whole cycle of the claim.
This can lead to additional costs in training and educating staff on the
multiple systems and the need for accuracy.
In my position we currently have a plan implemented to change to a
single billing system within the next 3 years.
I think this will be the future of revenue cycle and it is essential to
integrate processes into a one-stop shop type system. If staff members can find the information
they need to make changes all within the same system it can improve quality,
productivity, and patient satisfaction.
The main problem with this is that it can be costly to upgrade systems
and train employees on new technology.
Despite the costs I think that this is an investment that is worth it
for companies and patients to improve healthcare and lower costs.
Effective healthcare revenue cycle management is a process that must
be monitored closely in order for necessary changes to be made. One
major change and obstacle healthcare providers face in managing a good
revenue cycle is the effective use of technology. As the industry of
healthcare evolves, technology has been integrated into almost every
administrative process that is performed, and this includes revenue
cycle management which embodies the charge capture process. The charge
capture process is the process of reimbursement for services performed
by the healthcare provider. The reimbursement process revolves around
the correct entry of codes and descriptions of services so that a
clinical professional may select the proper service that was performed
in order to be reimbursed for that specific service. Technology has
created some barriers to this charge capture process. As the age of
physical records fades and electronic records become more prevalent the
clinical work force must be provided the proper technology to house such
records and effectively manage services they provide. With this being
said, the clinical work force must also be willing to learn the new
technology utilized including software and databases to correctly code
and record services performed. This in turn creates a new training area
for clinical staff that is already run down by providing care to their
patients and do not have time to spare for egregious and simply boring
I believe that outsourcing revenue cycle management
is an important aspect for healthcare providers to consider. In the
HFMA article “HFMA Awards GE Healthcare Revenue Cycle Technology with
Peer Review Designation for Superior Productivity, Data Accuracy and
Value,” by Karen Thomas, we learn that GE Healthcare has created
Centricity Business as a revenue cycle management solution. From peer
reviews, 96% of industry executives indicated that the solution delivers
good value for the cost. This business solution has the capability of
moving records to an electronic basis and creating singular patient
files for ease of access and clarity of information. I believe
technology integration is a major component of effective revenue cycle
management as the healthcare industry begins to rely on technology to
improve processes, decrease human error, and increase patient
The last respond on the first or the second post you make choose one and respond to it,