Job Functions Entails Educating The Revenue Cycle

Introduction

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.

Demonstration of Proficiency

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

• Competency 3: Explain the organizational revenue cycle process.
  • Explain the purpose of each step in the revenue cycle process.
  • Describe key responsibilities of individuals who work in the revenue cycle process.
  • Explain the consequences to the organization of failing to fulfill key responsibilities in the revenue cycle process.
  • Explain 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.

Instructions

For this assessment, prepare a 10-slide PowerPoint presentation outlining the various steps of the revenue cycle. For the scenario, imagine you are a patient access supervisor who must educate a group of new hires about the revenue cycle process. The presentation should include:

• The revenue cycle process.
• Their potential responsibilities.
• Why the process is important to a care organization.
• Challenges that they might face in their work.

When structuring your presentation, consider the following points and questions to ensure that you are meeting the scoring guide criteria:

• Explain the purpose of each step in the revenue cycle process.
  • “Explain” means to make (an idea, situation, or problem) clear to someone by describing it in more detail or revealing relevant facts or ideas.
  • The steps within the revenue cycle process including admissions, case management, documentation, coding, billing, and other steps.
• Describe key responsibilities of individuals who work 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.
  • Describe key components (such as verifying insurance, financial counseling, coding of documented services provided, and others) and who is responsible (individuals such as coders, registration clerk, and others).
• Explain the consequences to the organization of failing to fulfill key responsibilities in the revenue cycle process.
• Explain 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 that 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.
• Apply APA formatting to in-text citations and references.
  • Be sure to include a separate references slide.

Record audio for this presentation. You can record directly into your PowerPoint presentation, or through Kaltura. You may wish to consult these resources before starting your assessment:

• Guidelines for Effective PowerPoint Presentations [PPTX].
• Using Kaltura [PDF].

Submit your completed PowerPoint Presentation as an attachment in the assessment.

Additional Submission Requirements

• Media presentation: Use the Revenue Cycle Process template [PPTX] provided. Create 10 slides you would present in 10–20 minutes, plus an APA-formatted reference slide at the end of the presentation.
• Resources: Cite at least three scholarly resources.
  • 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 the APA resources located in the courseroom navigation panel.
• 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.

SCORING GUIDE

Use the scoring guide to understand how your assessment will be evaluated.VIEW SCORING GUIDE