The back end is where claims are corrected appealed and finalized Harrington

The back end is where claims are corrected appealed

This preview shows page 2 - 6 out of 15 pages.

corrected, appealed and finalized (Harrington 211).As stated before many departments are involved on the care of the patient. To exemplify, let’s assume a patient comes into the emergency room after a car accident. The emergency de-partment personnel start the process by taking information from the patient or ambulance team. Radiology is then called to perform x-rays and MRI. Blood and urine are taken to the lab to de-termine if any intoxication or other underlying problems are present. It is determined that the pa-tient needs surgery to repair a broken leg, therefore they are taken to the OR where surgeons re-pair the bones. The patient is finally admitted to the Orthopedic floor and taken care of for a few
Background image
days to make sure nothing else happens and is recovering correctly from surgery and the acci-dent. During those days the patient receives care, food, medications, and the room. During this entire time the nursing staff, physician, financial department, HR, administrators, laboratory, ra-diology, and pharmacy all are involved in this patient care and their chart. This whole process needs to run hand in hand with the revenue cycle and how everything is tracked.
Background image
The Case Management falls within the middle process of the RCM tier and may as well be the most important department. The middle process focuses on “balancing clinical practice guidelines and to document services completely and accurately and to ensure the coding of docu-mented service is accurate to ensure reimbursement” (Harrington 217). The Case Manager knowledge to make sure the documentation is correct before it is sent for processing. Accuracy is key in maintaining the revenue cycle running as smoothly as possible in a timely manner.Reimbursement plays an important role in the hospital and how it functions, but an evenlarger part of the process is the departments who take part in the reimbursement. Proper pro-cessing starts with training and maintenance in the facility. For revenue cycle to be efficient it requires a strong team working together ‘from registration and admissions to the servicing de-partment, care management, finance, health information management, and clinical staff all need to work together to effectively initiate, implement, and manage the revenue/reimburse-ment for a healthcare facility’ (Harrington 210). All departments are intertwined. Important de-partments that are involved are the thedepartments that impact reimbursement are clinical services, patient accounts, health information management, and administration (Harrington, 2016 p.13).The departments that impact reimbursement are clinical services, patient accounts, health information management, and administration (Harrington, 2016 p.13). Clinical services are where all clinical documentation is completed including registration and insurance verifica-tion. This department ensures that proper verification of coverage as well as demographics for the patient have been collected and confirms services rendered to patient and efficiently bills the patient or insurance company. The charge master is in the hands of the administrative team
Background image
or the chief financial officer.
Background image
Image of page 6

You've reached the end of your free preview.

Want to read all 15 pages?

  • Winter '14
  • Harrington

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture