For one of the studies for this assignment, you conducted independent research into health care revenue cycles and billing processes. You will be incorporating this infor
For one of the studies for this assignment, you conducted independent research into health care revenue cycles and billing processes. You will be incorporating this information into your assignment.
Imagine that you have just stepped into a new role as the office manager for a successful medical clinic. The clinic is a conglomeration of physicians offering specialized care. Each physician group tried to manage its own billing process. It quickly became clear that one billing office would be more efficient. You realize a lack of consistency has existed in the clinic and that you will need to update the billing policies and procedures immediately. You also recognize that people often resist change. One way to minimize this resistance is to provide credible evidence supporting the changes you plan to make.
You assignment is to prepare a proposal for the physicians about the billing policy and procedure changes you plan to make. To help ensure buy-in from the physicians, you will provide relevant evidence to support each change.
Instructions
Write a proposal for changes you would like to make to the billing policies and procedures for a physicians' clinic. Include all of the following in your proposal:
- Explain how the proposed changes will benefit the patients, physicians, and the clinic.
- Develop a step-by-step process for the entire revenue cycle, from preverification of insurance to accounts receivable management.
- Recommend a method for determining a pricing structure.
- Be sure to consider the factors that influence pricing.
- Explain the factors to be considered when negotiating insurance contracts.
- Determine the major payer categories appropriate for this practice.
- Explain how the clinic will handle private pay and charity care.
- The discussion in this unit will help you with writing this portion of your proposal.
- Recommend an installed or a web-based billing software system.
- Do not recommend a specific software brand, just the type of software needed.
Note: To increase physician buy-in, remember to provide a minimum of three current scholarly and/or authoritative resources to support the changes you are recommending. These resources should be over and above the resources provided to you in this unit's studies.
Submission Requirements
- Written communication: Be sure that your proposal is clear, logical, and succinct. It also needs to be free of errors that detract from the overall message.
- Length: 3–4 double-spaced content pages in Times New Roman, 12-point type.
- Title and reference pages: Include a title and a reference page. Include a minimum of three references to current scholarly and/or authoritative resources. These resources need to be over and above the resources identified for you in this unit’s studies. Current means no more than five years old.
- APA format: Ensure in-text citations and references adhere to APA format. For an APA refresher, consult the APA Style and Format page on Campus.
- Scoring guide: Review this assignment's scoring guide so that you understand how your instructor is going to evaluate your work.
Note: Your instructor may use the Writing Feedback Tool to provide feedback on your writing. In the tool, click the linked resources for helpful writing information.
Resources
Billing Policies and Procedures Scoring Guide
Due Date: End of Unit 4 Percentage of Course Grade: 20%.
|
CRITERIA |
NON-PERFORMANCE |
BASIC |
PROFICIENT |
DISTINGUISHED |
|
Develop a step-by-step process for a revenue cycle. 14% |
Does not develop a step-by-step process for a revenue cycle. |
Develops a process for a revenue cycle, but omissions and/or errors exist. |
Develops a step-by-step process for a revenue cycle. |
Develops a step-by-step process for a revenue cycle. Process explains each step’s function. |
|
Recommend a pricing structure method. 14% |
Does not recommend a pricing structure method. |
Describes one or more pricing structure methods, but does not recommend one. |
Recommends a pricing structure method. |
Recommends a pricing structure method. Recommendation explains how the pricing structure method supports the organization’s financial strategies. |
|
Explain how billing process changes benefit patients, physicians, and the clinic. 12% |
Does not explain how billing process changes benefit patients, physicians, and the clinic. |
Explains how billing process changes benefit patients, physicians, and the clinic in minimal depth and detail. |
Explains how billing process changes benefit patients, physicians, and the clinic. |
Explains how billing process changes benefit patients, physicians, and the clinic. Explanation includes multiple examples and references to current scholarly and/or authoritative sources. |
|
Explain the factors to consider for insurance contract negotiations. 13% |
Does not explain the factors to consider for insurance contract negotiations. |
Explains the factors to consider for insurance contract negotiations in minimal depth and detail. |
Explains the factors to consider for insurance contract negotiations. |
Explains the factors to consider for insurance contract negotiations. Explanation identifies the major payer categories appropriate for the practice. |
|
Explain a process for handling private pay and charity care. 13% |
Does not explain a process for handling private pay and charity care. |
Explains a process for handling private pay and charity care in minimal depth and detail. |
Explains a process for handling private pay and charity care. |
Explains a process for handling private pay and charity care. Explanation shows how the process fits into the organization’s financial strategies. |
|
Recommend a billing software system. 14% |
Does not recommend a billing software system. |
Describes one or more billing software systems, but does not recommend one. |
Recommends a billing software system. |
Recommends a billing software system. Recommendation compares the benefits and limitations of each in terms of the organization’s needs and financial strategies. |
|
Write content clearly and logically with correct use of grammar, punctuation, and spelling. 15% |
Does not write content clearly and logically or with correct use of grammar, punctuation, and spelling. |
Writes content; however, lapses, omissions, and/or errors exist. |
Writes content clearly and logically with correct use of grammar, punctuation, and spelling. |
Writes clear, logical, and error-free content. Provides relevant evidence to support proposed changes. |
|
Format citations and references in APA style. 5% |
Does not format citations and references in APA style. |
Formats citations and reference in APA style; however, omissions and/or errors exist. |
Formats citations and references in APA style. |
Formats citations and references in APA style, without errors. |
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