A 50-year-old woman has been experiencing a chronic cough for the past two months. She is a two-pack a day smoker and has been for the past 30 years. She sees her PCP for the cough
A 50-year-old woman has been experiencing a chronic cough for the past two months. She is a two-pack a day smoker and has been for the past 30 years. She sees her PCP for the cough and is given an order for a chest x-ray at the local hospital. The x-ray report states “nodule in lower lobe of right lung, worrisome for malignancy.” The PCP refers her for a biopsy of the nodule at the ambulatory surgery clinic, which substantiates the diagnosis of cancer in the pathology report. Two weeks later, the same physician who did the biopsy performs a right lower lobectomy. Prior to discharge after surgery, the patient develops an infection, and the infectious disease specialist is asked to evaluate her and recommend the appropriate treatment course. Upon discharge, she receives care in her home for the next two weeks. Four weeks after surgery, radiation therapy is initiated, but her condition continues to deteriorate over the next few months with metastasis to the brain noted, at which point she decides to receive only palliative care.
a. Classify the providers for each stage of the patient’s care noted above and outline their responsibilities.
b. Explain the documentation that each provider will be creating as part of the patient’s record.
c. Suppose the patient’s insurance company denies claims for services. Which department(s) are responsible for identifying and correcting revenue cycle problems?
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