Purdue University Global Revenue Cycle Monitors Question

Instructions:

  • Completing this assignment will assist you in the completion of your Unit 9 Assignment.
  • Review the information on revenue cycle monitoring tools in all of your reading and in a Word document, address the following issues:
    1. Identify tools and techniques used to improve health care finance and discuss the role technology plays in successful revenue cycle management.
    2. Review two of the monitoring tools and describe their purpose and how they “monitor” the finance health of an organization.
    3. Research implications of adopting a new EHR system on the information systems related to RCM and reporting. Select three of the considerations below to research. Provide a review of the selected items, including the information you can find in each.
      1. Corrective Coding Initiative (CCI)-Electronic Billing X12N
      2. Compliance strategies and reporting
      3. Audit process (compliance and reimbursement)
      4. Revenue cycle process
      5. Utilization and resource management

Expert Solution Preview

Introduction:
Healthcare finance is critical for the success and sustainability of any medical organization. Therefore, health professionals must use tools and techniques to monitor and improve revenue cycle management (RCM). Technology plays a vital role in enabling healthcare finance professionals to efficiently and effectively manage revenue and billing operations.

1. Identify tools and techniques used to improve healthcare finance and discuss the role technology plays in successful revenue cycle management.

Healthcare organizations use various tools to improve finance, including electronic health records (EHR), revenue cycle management software, and patient billing systems. Technology streamlines and automates healthcare finance processes, from claims submission to payment processing. These tools help healthcare organizations improve financial management, identify revenue cycle issues, and make data-driven decisions.

2. Review two of the monitoring tools and describe their purpose and how they “monitor” the finance health of an organization.

a) Revenue cycle management software: This tool ensures that all claims are accurately and promptly submitted and processed, resulting in maximum reimbursement. It monitors the entire revenue cycle, from patient registration to final payment receipt. Healthcare finance professionals use this tool to analyze and improve billing processes, prevent claim denials, and resolve erroneous claims quickly.

b) Accounts receivable (AR) management software: This tool monitors and tracks payment receivables and collections, including insurance claims. It helps healthcare organizations identify and resolve denied claims, control bad debt, and increase revenue.

3. Research implications of adopting a new EHR system on the information systems related to RCM and reporting. Select three of the considerations below to research. Provide a review of the selected items, including the information you can find in each.

a) Corrective Coding Initiative (CCI)-Electronic Billing X12N: The adoption of a new EHR impacts the Corrective Coding Initiative (CCI), which identifies incorrect codes and services to avoid inappropriate payment. Electronic Billing X12N provides standardized billing methods, and healthcare organizations must comply with updated coding protocols to ensure accurate billing and reimbursement.

b) Compliance strategies and reporting: Introduction of a new EHR system requires healthcare organizations to implement new compliance strategies and reporting policies. Compliance officers must ensure that the new system complies with HIPAA regulations, and data security measures are strictly in place.

c) Audit process (compliance and reimbursement): With EHR data accessible at a click of a button, the auditing process becomes more rigorous and comprehensive. Auditing helps identify areas of improvement in compliance and reimbursement matters. To maintain accurate records, healthcare organizations must monitor financial records continually.

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