Question

IV. Revenue Management

4.A. Revenue Cycle & Reimbursement

1. Apply policies and procedures for the use of date required in healthcare reimbursement

Curricular Considerations

• Evaluate medical necessity (data management, Case management, [CDMP] Clinical documentation management program)

Domain IV Revenue Cycle Management (RHIT Exam)

3. Conduct utilization review

Chapter 9 Improving the Provision of Care, Treatment, and Services

• Read chapter 9 and using the case study below answer the questions (do not use the questions in the textbook).
• Read Real-Life Experience

Chapter 9 Additional Student Activity

Read - "QI Toolbox Technique" and Table 9.1 Joint Commission Core Measure criteria set - Stroke pages 182-184

Using the data collection form (Excel file) provided to record the patient information from the stroke cases. There are two patient records provided here for students:

Case 1 is on John Doe;

Case 2 is on Catherine Brown;

Read each patient's record, go to the Excel file (Stroke Data Collection Form). The core measures criteria for a stroke are listed in the first column. (You will find them in Table 9.1 in the textbook, also.) Abstract the information (for each patient) in the column labeled for that particular patient. After you read the record, find the documentation in the record that either meets each criteria or does not meet the criteria. If it doesn't meet tell why it does not meet the criteria and where you found the information. Document where you found the information in the record, i.e. history and physical, progress note, etc.

Next, students should abstract the stroke criteria from these three patient records.

Complete the Excel file called Stroke Data Collection Form. Finally, the students could also develop a report of their findings.

Answer 1

REVENUE MANAGEMENT

REVENUE CYCLE AND REIMBURSEMENT

Health care revenue cycle management is the financial process that facilities use to manage the administrative and clinical functions associated with processing payment and revenue generation

healthcare revenue cycle management is the strategy that healthcare organization use to pay the bill.

factors effect on revenue in practice included are

• provider productivity
• patient volume
• fee for services
• insurance claims
• payments
• collections

factors influencing your revenue cycle are :

work flow : activities related to billing like collection of documents , appropriate diagnosis, procedure codes and submitting claim.

use of technology:

technology used for to get good clinical outcomes by reducing delay and denials and payments

Team

Awell qualified team    important for revenue at your practice that will impact on your revenue and operations

data management

data required in health care management by storing protecting and analyzing data

• data management improve the patient data analysis
• assess the health care out come
• understand the physician data
• improves to reach data

case management : it is define as determine the health situations of the patient , planning for and coordinating the most economical health care for the patient . it reduces length of stay for patient it decreases the readmissions

clinical documentation process of digital analog of record of medical treatment and clinical documentation.

REIMBURSEMENT it will focus on the service , coding accurancy , supply chain management and pricing transparency will strenghth RCM and reimbursement .

conducting utilization review by health insurance companys by review a request for medical treatment. it helps to minimize costs and determine if the treatment is appropriate

utilization review is on appropriateness and quality of services.

• utilization review by three aspects 1.prospective
• 2.concurrent
• 3. retrospective