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.
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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 difficulties.
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.
In 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 tech training.
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 satisfaction.
The last respond on the first or the second post you make choose one and respond to it,