Revenue Cycle Workflow Assignment <Sue Hayes> Scenario 1 During the process of preparing a claim for submission, an edit was encountered indicating there were surgical charges on the claim, but there are no ICD-10-PCS codes to correspond with any surgical services. Which Departments would be involved in resolving the issue? What role does each department play in remedying the situation? HIM/Coding and Patient Accounts/Billing Departments Him will add or remove the edit and notify the billing department so they can submit the bill for processing. Scenario 2 The Release of Information (ROI) vendor reports to the HIM Department. In response to a request for records, the ROI Vendor disclosed a copy of the patient’s records to the patient. Upon reviewing the records, however, the patient contacted the ROI department indicating the records are not her records, stating she never received the treatment/services documented on that date of service; in fact, she was not a patient on that date. It is likely that the wrong patient demographics were attached to the patient encounter at the time of admission. Which Departments would be involved in resolving the issue? What role does each department play in remedying the situation? HIM and Patient access Departments. HIM/coding would need to work with the Patient Access Department or Admissions because as part of the registration process they’re responsibilities include patient intake or registration, insurance verification, precertification, master patient index cleanup, verification of patient demographics
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- Fall '18
- Allie Kotzian
- Health care provider, Magnetic resonance imaging