The overarching goal of revenue cycle management (RCM) is not only to reduce costs incurred by the provider, but also to increase the quality of care availed to the patient. To enable this, the RCM is broadly divided into three key areas Front End, Mid Cycle, and Back End. Each of these three key areas is further divided into two to three distinct categories, each of which feeds into the next. (You may refer to the infographic provided in the lecture as a reference.)
Which area and categories of the revenue cycle is most influential towards cost evaluation and containment?
Which area and category of the revenue cycle is most influential towards quality of care evaluation and improvement?
Kenzie Weldon
MondayJun 12 at 1:45pm
Manage Discussion Entry
I think the area and category most influential towards cost evaluation and containment is under the Front-End within Financial Verification. The financial verification section of revenue cycle management is all about collecting and verifying forms of patient payment. The Front-End is able to see if a patient is able to pay for a service using insurance as they intended, or if a service is not able to be covered by a patient’s specific plan. If this is the case, a patient may change their mind about the services they are receiving from the facility, however, a financial counselor could be able to go over different options for payment with the patient in order to ensure they are receiving the quality care they deserve. It also ensures that if a patient is using insurance to cover the cost of their services, that the facility is collecting the copayment that the insurance requires. I also think the Charge Capture under the Mid-Cycle is important for containment because it records the services and supplies that were used for patient care. If facilities were not keeping track of this information, communication between them and insurance companies would not be nearly as efficient.
The area and category I think is most influential towards quality of care evaluation and improvement is within the Mid-Cycle under Clinical Functions. Case management is a big part of this section, and it works to ultimately reduce costs for the patient by ensuring the facility is avoiding unnecessary tests and procedures. From the time a patient enters a facility to the time they are discharged, there is a case manager assigned to the patient in order to properly facilitate their care. This is incredibly important for quality of care and it allows team members to properly care for their patients.
Kenzie Weldon and
Courtney Wilkerson
MondayJun 12 at 11:10pm
Manage Discussion Entry
Good evening,
After reading up on RCM or revenue cycle management which helps with reducing costs and increasing the quality of care. The area and categories of the revenue cycle that is most influential towards cost evaluation and containment is the Front end, mid cycle and back end. In the front end it would be the category of financial verification where they verify that the patient can pay for the services. The mid cycle category is charge capture, which indicates all services rendered to the patient. And finally, the back-end category is both claims processing and receipt of reimbursement. The area and category of the RCM that is most influential towards quality-of-care evaluation and improvement is case management under clinical functions because the case manager manages what tests, and such are completed in align with what the patient needs at the moment.
-Courtney Wilkerson
References:
Harrington, M. K., & Harrington, M. K. (2024). Chapter 10. In Health Care Finance and the mechanics of Insurance and Reimbursement (pp. 178–186). essay, Jones & Bartlett Learning.
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