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White Paper 1White PaperHCM345 Final PaperRobin Fulson02-25-2018
White Paper 2IntroductionHealth care has developed from paying cash to the doctor at the time of the visit to the advancement of insurance companies covering the payment for the visit. Patients have had different responsibilities when paying for their services over the years. These ranged from payingthe provider first and being reimbursed from the insurance company in a major-medical environment to having a pay a copayment to the provider and the insurance paying the provider directly(Harrington,2016). The transition from fee-for-service environment to a prospective payment environment, the Revenue Cycle Management(RCM) has become a very important partof managing a healthcare facility. The focus of this process is to ensure the facility will be paid for the services (Harrington, 2016).Reimbursement and the Revenue CycleThe reimbursement approach in health care has gone from a simple fee-for-service to a more complex approach called Revenue Cycle Management (Harrington,2016). A successful RCM involves the revenue cycle manager and management team to develop and implement policies, procedures, and performance measures and standards. An important feature is the revenue cycle friendly third-party payer contracting that includes negotiating patient volumes, prices, and contractual allowances as well as payment terms and timing (Rauscher, Wheeler, & Hilleary,2008). When services are provided to the patient and no payment was rendered for the services, the facility will not receive cash and the employees’ income will be affected. The hospital would need to review the charge capture to make sure the recording of services
White Paper 3supplies, or items delivered to the patient are correct. The hospital should also review the charge description master to identify the item used, the charge associated with it, and the code associated with it (Harrington, 2016). There are several parts of the cycle that have responsibilityof their own functions. The overall goal is to submit a clean claim for services rendered at the healthcare facility (Harrington, 2016).An effective model of the RCM is divided into three categories: front-end, middle, and backend process (The Revenue Cycle and The Hospital Revenue Cycle. The beginning of the revenue cycle is before patient contact. The beginning of the cycle includes: development and implementation of policies and procedures, performance measures and third-party payer negotiation and management (Harrington, 2016). During the front-end process the provider can verify the patient demographics and secures the source of payment. The front-end process also identifies any requirements from the insurance company prior to service (Harrington, 2016).