BHA 4009 Capella University The Revenue Cycle Process Presentation

The financial health of the health care organization depends upon its ability to generate consistent and recurring funds from the services it provides. Collectively referred to as the revenue cycle (RCM), critical stages in this process include:

• Patient registration.
• Collection of demographics and payor source.
• Rendering services.
• Documenting services.
• Establishing charges.
• Preparing the claim or bill.
• Submitting the claim.
• Receiving payment.
• Managing accounts receivable.

Decreasing payment delays and lost revenues is a point of interest for many health care managers tasked with oversight of the RCM process. Innovative approaches in technology have assisted with streamlining the RCM process and allowed for automation of many processes, resulting in expedited processing and quick remittance.

Managed care dollars represent a significant portion of all health care organizations’ reimbursements. As a result, health care organizations seek to establish contracts with large managed care organizations (MCOs). Negotiating and securing contracts with MCOs is important for several reasons, including preserving revenues, enhancing patient satisfaction, and generating additional sources of revenue.

All contracts will contain language outlining the administration of the contract along with the payment schedule. While the payment schedule may be seen as the most important element, the terms outlined within the contract are equally as vital to the financial success of the organization.

This assessment focuses on the revenue cycle and how technological innovations have impacted reimbursement for health care organizations. You will take on the role of a patient access supervisor. One of your job functions entails educating new hires on the revenue cycle process.

Demonstration of Proficiency

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

• Competency 3: Explain the organizational revenue cycle process.
  • Identify key steps of the revenue cycle process.
  • Explain the purpose of each identified step in the revenue cycle process.
  • Describe key components of each function in the revenue cycle process.
  • Explain the consequences of failing to conduct the function identified.
  • Explain additional steps and challenges in the revenue cycle process when working with an uninsured patient.
• Competency 4: Communicate in a manner that is scholarly, professional, and respectful of the diversity, dignity, and integrity of others and is consistent with health care professionals.
  • Demonstrate effective communication through writing and proper use of APA style with no significant errors, and supports analysis and recommendations with appropriate current literature.

Instructions

For this assessment, prepare a 10-slide PowerPoint presentation outlining the various steps of the revenue cycle. For the scenario, imagine you are a patient access supervisor who must educate a group of new hires about the revenue cycle process, including:

• The revenue cycle process.
• Their potential responsibilities.
• Why the process is important to a care organization.
• Challenges that they may face in their work.

Record audio for this presentation. You can record directly into your PowerPoint presentation, or through Kaltura. You may wish to consult these resources before starting your assessment:

• Guidelines for Effective PowerPoint Presentations [PPTX].
• Using Kaltura [PDF].

Before you begin, be sure to review the scoring guide. When structuring your presentation, consider the following points and questions to ensure that you are meeting the scoring guide criteria:

• Identify the various steps within the revenue cycle process, including admissions, case management, documentation, coding, billing, et cetera.
• Provide the following for each step identified:
  • Purpose of the step identified.
  • Responsible functions completed by individuals, such as coders, registration clerk, et cetera.
  • Key components of the function, such as verifying insurance, financial counseling, or coding of documented services provided.
  • Consequences of failure to properly conduct the function identified.
• Provide information for the new staff regarding options available for the uninsured.
• Identify any additional steps throughout the revenue cycle one must be aware of when working with an uninsured patient.
• Identify the challenges that exist for the revenue cycle due to the delivery of uncompensated care.

Additional Submission Requirements

• Communication: Communicate in a manner that is scholarly, professional, respectful, and consistent with expectations for professional practice in education. Original work and critical thinking are required regarding your assessment and scholarly writing. Your writing must be free of errors that detract from the overall message.
• Media presentation: Create 10 slides you would present in 10 to 20 minutes, plus an APA-formatted Reference slide at the end of the presentation.
• Resources: Cite at least three scholarly resources.
  • Your textbook can be one of the three.
• APA guidelines: Use APA style for references and citations. When appropriate, use APA-formatted headings. For more information, refer to the APA resources located in the courseroom navigation panel.
• Font and font size: Times New Roman, using appropriate size and weight for a presentation, generally 24–28 points for headings and no smaller than 18 points for bullet-point text.