A third-party payer manages healthcare expenses for the insured (patient) and other covered parties and provides reimbursement for treatment and services covered under a contractual agreement between the insured and the payer.
Third-Party Payer Comparisons
A third-party payer manages healthcare expenses for the insured (patient) and other covered parties and provides reimbursement for treatment and services covered under a contractual agreement between the insured and the payer. Several examples of third-party payers include HMOs, PPOs, Medicare, and Workers’ Compensation. Select two of the third-party payers to compare and contrast based on your readings.
Consider in your discussion the differences and similarities in access to providers, choice of provider, out-of-pocket costs to the patient such as required co-pays and coinsurance and deductibles, and appeals for denied services. Identify based on your comparisons which type of plan you would prefer as a patient and why.
In your reply post, comment on at least one of your classmates’ discussion and choice of plan and how it compares to your choice.
HIM2133 Revenue Cycle and Billing
Module 3 Discussion
Electronic Claims Processing
Heritage Medical Center is converting to electronic claims processes after years of using paper forms. Compare and contrast the PHI privacy and security concerns that may result from the use of an electronic claims submission process to those that are likely to occur with paper claims. Include a minimum of one potential privacy concern as well as one concern related to security.
Additional Notes:
The discussion is to focus on the concerns relative to the claims processing procedures. What will change with the electronic processing of claims that is different from processing paper claims?
Specify in your narrative when you are addressing privacy concerns vs the security concerns to provide clarification to the reader.
Include a minimum of one Privacy concern and one Security concern.
Provide APA in-text citations and references for the sources you utilize in preparing your response.
In your reply posts, respond to at least one other student’s discussion post indicating whether or not you agree with the concerns they have identified and state your reasons for agreement or disagreement.
HIM2133 Revenue Cycle and Billing
Module 4 Discussion
Error-Proofing the Chargemaster Process
Read the article Charging vs Coding (Pilato, 2013). Choose one area of disconnect mentioned in the article and describe the issue along with a suggestion for error-proofing the process. Indicate why the error-proofing method would be effective in the area of disconnect chosen.
In your follow-up posts, respond to one student’s post. Comment on their suggestion for error-proofing the process, and offer other suggestions.
Reference
Pilato, Jeff, MHA,R.T.R., C.P.C.-H. (2013). Charging vs. coding. Journal of AHIMA, 84(2), 58-61. Retrieved from https://search.proquest.com/docview/1282108260?accountid=40836
HIM2133 Revenue Cycle and Billing
Module 5 Discussion
NCCI Edits and Medically Unlikely Edits
The National Correct Coding Initiative (NCCI), also known as CCI, was established to promote correct coding and avoid inappropriate payment to providers. Review the article How to use the NCCI Tools. Based on your course readings and review of the NCCI Tool, explain what you think the impact would be on payment to the provider if these edits weren’t used.
In your reply post, comment on one other student’s idea of the impact on payments to the provider as it compares to yours.
HIM2133 Revenue Cycle and Billing
Module 6 Discussion
Revenue Cycle Performance Benchmarks
The Healthcare Financial Management Association (HFMA) has identified a number of key revenue cycle performance measures. Several of the measures are listed below. Choose three of the following performance measures/benchmarks identified by the HFMA. Based on your readings, indicate how improvement in the benchmark enhances revenue cycle performance (for example, improved cash flow, improved turnaround on billing, or increased collections). More than one benefit might be applicable to each benchmark. Your post should demonstrate how improvements in these metrics relate to the overall goals of the revenue cycle. (Reference earlier chapter readings and Lesson Content regarding revenue cycle performance improvement considerations.)
Decreased days in accounts receivable
Coder productivity
Reduction of encounters that are Discharged, No Final Bill (DNFB)
Decrease in Wrong Medical Record Number Assignments
Decreased turnaround on discharge deficiency analysis (missing documentation)
Implementation of point-of-service collections
Decreased rejections or denials
You can do this in either a written narrative, data table or a power point format. Organize your information so that it is reader friendly and makes the information clear.
Example:
Performance Measurement
Specify How Improvement Enhances Revenue Cycle Performance
Impact on Overall Revenue Cycle Goals
HIM/Record Management (NOTE-choose 3 measurements from the above list. Do not use this measurement in your post-example only)
-Accuracy of records supports optimization of revenue
-Access to records supports timely billing
Data Quality
Reduction in denials
Improved revenue turnaround
If you use external sources to help you formulate your discussion post, be sure to include citations for those sources.
In your follow-up post, reply to at least one other student. Comment on the benchmarks that the student selected and indicate what you have learned from his or her analysis of the performance metrics.
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