ipl-logo

Revenue Cycle In Health Care Essay

588 Words3 Pages

Taking care of the sick has turned into a lucrative business. Healthcare must effectively manage and maximize their revenues. To accomplish that, there must be a revenue cycle in place. The revenue cycle consists of six stages and as follows: Provide services, document services, establish charges, prepare claim/bill, submit claim, receive payment. (Cleverley, Song, Cleverley, 2011, pg. 15). For healthcare providers, accomplishing the stages brings a significant degree of difficulty.
The factors that contribute to the difficulty of the revenue cycle in health care includes the nature and importance of the services provided. Documentation and billing can also be affected by the regulation factors. Different payment systems being utilized by multiple payers complicates the healthcare firms’ revenue cycles. (Cleverley, Song, Cleverley, 2011, pg. 14). With the stages of the revenue cycle, additional details …show more content…

Medical information is gathered and stored in a medical record for documentation purposes which is needed at the time for billing to the payer. Medical Records contain information required by The Health Insurance Portability and Accountability Act (HIPAA) of 1996. HIPAA requires “two categories of information be reported to payers: diagnosis codes and procedure codes”. (Cleverley, Song, Cleverley, 2011, pg. 17). There are two coding systems used to provide the required codes: International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and Healthcare Common Procedure Coding System (HCPCS). Diagnosis codes consists of three digits initially, and if necessary followed by a decimal point and one or two additional digits. Example: 122.25. Procedure codes are used when a service is provided such as surgery and have up to four digits. HCPCS codes are used for reporting both inpatient and outpatient procedures by physicians. (Cleverley, Song, Cleverley, 2011, pg.

Show More
Related
76 Words | 1 Pages

HCPCS level 1 uses CPT codes to identify medical services & procedures level 2 is used to identify the products, supplies, and services that are not in CPT codes ICD-10 used for diagnosis and in patient procedures There 's so many different types of services and procedures within the medical field that different codes are needed to specifically identify them properly. Coding was created to make medical billing simple. Proper coding will ensure accurate and timely reimbursements.

Read More
458 Words | 2 Pages

Initially, facilities voluntarily used HCPCS codes, but with the implementation of HIPAA in 1996, facilities began to report HCPCS for transaction codes (Webb, 2012). CPT (Current Procedural Terminology) is a medical code set that is used to report medical, surgical, and diagnostic procedures and services to entities such as physicians, health insurance companies and accreditation organizations (Rouse, 2015). The HCPCS level II coding system has a selected standard coding system with a wide acceptance among both public and private insurers. The HCPCS level II codes set are alphanumeric code set and primarily include non-physician products, supplies, and procedures not included in CPT. For HCPCS to bill the and identify the service that are been used such as.

Read More
1183 Words | 5 Pages

HCPCS codes facilitate the procedure of processing health insurance claims made by insurers such as Medicaid. The HCPCS is divided into two levels or classes. The task of classification lies with the Centres of Medicaid and Medicare Services (CMS) in association with the HCPCS work group and other third party payers. Classification is done quarterly, marking a significant step-up from its previous system of annual updates. Since 2014, the CMS has been implementing several changes regarding the continuation of HCSPCS level II.

Read More
1417 Words | 6 Pages

Increasing costs all around the globe due to economic downfalls is making this issue even more challenging. It is vital that we have some focus on revenue, but we can’t lose focus on the costs of running a business. In health care this can be very challenging because of all the changes involved with the government, in laws regarding health care reform. “Understanding the total costs of services will allow the redeployment of resources which provide a higher payback, or will facilitate the elimination of those resources altogether.” (Hughes, 2011).

Read More
352 Words | 2 Pages

HCPCS : A standardized coding system used to process claims for insurance payments by the Centers for Medicare and Medicaid Services. It consists of two parts: a coding system devised by the American Medical Associatio called the Current

Read More
690 Words | 3 Pages

As far as the costs associated with health care, they may be concerned with the suggested payment system. Being a CCE, they are required to obtain reimbursement through a risk-adjusted, capitated basis. In addition, patients are allowed to choose health plans that best fit them and can change plans at any point. Furthermore, CCE must compete for patient based on their value and quality of service that they provide. In addition, the providers have various criteria that they must meet.

Read More
404 Words | 2 Pages

It represents supplies and non-physician services not covered by CPT codes and is alphanumeric always starting with a letter. HCPCS was optional until HIPAA became effective. Now HCPCS are used to describe the use or sale of healthcare equipment and supplies, also known as durable medical equipment (DME), that are not identified in Level I, CPT codes. There is a wide acceptance for this coding between private and public insurers. Required to report most items provided to Medicare and Medicaid patients and by most private payers.

Read More
523 Words | 3 Pages

A core element of confidence building is showing the professionals how to value and use information adopted for coded data. This type of information has the power to describe medical necessity in support of admissions, readmission’s and continued stays. An example I would like to give is, by pinpointing

Read More
553 Words | 3 Pages

Some variability differs with the capability of providing out-of-network health providers and the services in which can be provided. By having a broad range of choices that can be provided, will cause a higher the cost for the individual that is paying. Most Medicare patients have received the managed care plans due to promises of a lower copayment amount and often medication benefits. Medicare post-acute spending has grown rapidly with the number of users between 1999 and 2007. The growth in Medicare short-term post-acute service use, in part, reflects short hospital stays and a growing demand for rehabilitation services.

Read More
475 Words | 2 Pages

The complication and comorbidities are then defined as “standard” or “major”. The greater the severity means a greater level of care, which usually means a greater reimbursement. If the records are unclear regarding the degree of the condition, the coder may not be able to capture the code that will yield a higher reimbursement. Physician reimbursement and coding to support it are critically important to the sustained health of any physicians practice.

Read More
1010 Words | 5 Pages

A patient is going to have a different idea of how a health care should be managed. This in contrast to the way a physician may think the administration should be managed. Furthermore, each different stakeholder involved would have their own ideal reasons to why the health care administration

Read More
858 Words | 4 Pages

The Managed Care Organizations it continues the expansion of the products. The MCO business models it changes the services in mixing and volume of the patients and the representation on the multi-year contracts. It provides profiling to the current

Read More
898 Words | 4 Pages

In palpable markets, information is often not only difficult to come by but also restricted by those who hold power – and locating this “equilibrium” price is an arduous if not impossible task. The market for medical services may best exemplify this. In the medical market, prices vary depending on one’s HMO, whether they have insurance or not, and the facility performing the service – among other factors. Even if one could find the theorized “equilibrium” price for a medical service by painstakingly extracting all pricing information. One must ask if the same service is being provided at that given price?

Read More
1152 Words | 5 Pages

Introduction One of the biggest challenges in managing medical practice is managing cash flow. In theory, it seems as simple as providing a service, then collecting the payment. In reality, however, bad planning, insurance documents, high abstracted patients and lack of employee training often create collection inefficiency and cause cash flow problems. Multi-hospital system over the past 30 years, multi-hospital systems including tax exemptions and for-profit organizations have developed much faster than independent hospitals. Assume that the multi-hospital system has several advantages, including: • Better access to the capital market, thereby reducing capital costs • Eliminate repetitive services, thereby increasing the remaining site 's

Read More
557 Words | 3 Pages

What is a Certified Revenue Cycle Specialist? A Certified Revenue Cycle Specialist (CRCS) is a health care finance professional who obtained exclusive credentials through the American Association of Health Care Administrative Management (AAHAM). AAHAM Certifications The AAHAM is a national organization that provides certification exams, membership services and networking events for health care administrative professions.

Read More

More about Revenue Cycle In Health Care Essay

Related Topics

Open Document