The reimbursement issues dealing with revenue cycle management to educate the medical coders and financial department to determine any trends.

Concept to Consider:

Imagine that you are a financial analyst at a local hospital. You have been asked to coordinate the reimbursement issues dealing with revenue cycle management to educate the medical coders and financial department to determine any trends. This Assignment examines the components of the revenue cycle and needs to emphasize the methods for controlling cost by reducing errors.

Grading Criteria

Topics to Study

Suggested Resources

Part 1: Student demonstrated the ability to manage the use of clinical data required by various payment and reimbursement systems.

Clinical data management

Case mix management

Reimbursement management

Payment systems (i.e., PPS, DRGs,

RBRVS, RUGs, VBP, MSDRGs, commercial, managed care, and federal insurance plans)

Billing and reimbursement at hospital inpatient and outpatient, physician offices, and other delivery settings

Chapter 16 in Health Information Management by Latour, et al. (2013)

Chapter 17 in Health Information Management by Latour, et al. (2013)

Part 2: Student demonstrated the ability to take part in selection and development of applications and processes for chargemaster and claims management.

Chargemaster management

Chapter 16 in Health Information Management by Latour, et al. (2013)

Chapter 17 in Health Information Management by Latour, et al. (2013)

Part 3: Student demonstrated the ability to implement provider querying techniques to resolve coding discrepancies.

Query process (i.e., written, verbal, and template queries; timeliness and interpretation; and query retention)

Chapter 16 in Health Information Management by Latour, et al. (2013)

Part 4: Student created methods to manage present on admission (POA), hospital acquired conditions (HACs), and other CDI components.

Clinical documentation improvement

(CDI) metrics and reporting process

(i.e., concurrent, retrospective, and postbill review)

Chapter 16 in Health Information Management by Latour, et al. (2013)

Chapter 17 in Health Information Management by Latour, et al. (2013)

Part 5: Student evaluated capital, operating, and/or project budgets using basic accounting principles.

Budget process (i.e., capital and operating; staffing and budgeting)

Chapter 25 in Health Information Management by Latour, et al. (2013)

Part 6: Student demonstrated the ability to perform cost-benefit analysis for resource planning and allocation.

Accounting principles

Cost/benefit analysis (outsourcing and acquisition)

Chapter 25 in Health Information Management by Latour, et al. (2013)

Important: Please be sure to visit Academic Tools/Academic Success Center/Citation Guidelines to assist you with meeting APA expectations for this Assignment.