You are a staff member in the finance department at Nouveau Health, whose sole responsibility is to advance the success of the organization through assisting in planning, forecasting, and finance management. The chief executive officer (CEO) of Krona has asked that you complete the following:
· Explain how revenue cycle influences the building of the new hospital
· Discuss why increased outpatient services will be required to improve revenue in a bundled care, accountable care, valued based environment
· Discuss 3 ethical concerns in the new billing environment
Primary Post HCM410DBR5
Question 1
The appointment or visit to the hospital marks the beginning of the revenue cycle, which continues until the hospital receives complete payment for the services it has given. The revenue cycle consists of several processes, the most important of which are preregistration, registration, charge capture, claim filing, remittance processing, insurance follow-up, and patient collections. When constructing a new hospital, you must consider these stages to determine the best building layout. This will make things more convenient for the patient while simultaneously maximizing the space inside the building according to the needs.
Question 2
The development of outpatient services will increase total income due to this tactic, which opens up new financial avenues by creating new revenue streams. Because of this technology, the hospital can create bundled care packages and provide additional services that the patients would find helpful in meeting their healthcare needs. There are patients who, rather than traveling to the hospital for exams, would prefer to have their checkups conducted in the convenience of their own homes. This is because it would save them the hassle of making travel arrangements to go to the hospital.
Question 3
Honesty – You are responsible for protecting the patient’s medical information if you work in medical billing. In addition to that, you are dealing with customers and collecting payments. Because of this, the strictest degree of secrecy is required. Unacceptable and, in most circumstances, inappropriate behaviors include breaking the rules, theft, coding services that are not carried out, and unbundling processes.
Patient Rights – Patients have the right to have their care provided honorably. Many patients are at their most extreme vulnerability when they enter medical institutions. Patients should always be treated with respect, even when they make your life difficult; you should never put them down. This will result in satisfied customers, who will, in turn, provide credibility to the hospital via the continued support of its regular patients (Bucci, 2014).
Professional integrity – Maintaining a professional demeanor is essential while talking with patients and their insurance companies, colleagues, and anyone else you may run across during your employment. When communicating with someone face-to-face or over the phone, make an effort to maintain an outward air of composure and avoid becoming animated even in the face of challenges.
1. Hannah
The revenue cycle starts with patient registration and ends when the bill’s balance is paid in full (Niedzwiecki, 2007). This heavily influences the building of the new hospital since the bill may not be fully paid off for several months. The patient will have to finish their entire at the hospital and that can be anywhere from a few hours in the Emergency department to several weeks in the inpatient unit. After the patient is discharged and the services are complete, all claims must go through the insurance whether it is private or Medicare. Once the claims have been corrected and insurance has paid their portion, the bill is sent to the patient for their part. If the patient opts for payment plan, this can extend the time for the balance to be settled. Revenue cycles may show the hospital losing money for the first several months until the cycle is completed.
A large factor increasing the time between the patient registering and them paying the balance, is how long they stay in the inpatient ward. The medical professionals can provide the appropriate treatments and stabilize the patient enough for outpatient care, then more beds will be cycled through decreasing the revenue cycle time. An ethical concern would be financial gain versus the patient centered care. If the hospital is more focused on reducing the time spent on in the revenue cycle, corners may be cut with patient care, and they may be discharge too early. If the hospital is focused solely on providing quality patient care, then the patient may stay longer inside the inpatient unit increasing the length of time before the hospital is paid in full. The hospital may face another ethical concern by piling more services, possibly unnecessary but costly services, to make up for the time waiting for payment. A way to combat these two ethical concerns is to create a transition to outpatient through effective communication.
Outpatient Care
Outpatient physicians can meet with patients still in inpatient and provide consultation that will be billed under the outpatient care and not the inpatient care (Aapc, 2022). The patient can start a new treatment journey through the outpatient and the consultation will be billed for outpatient instead of adding to the inpatient service tally. Outpatient services provide several ways to improve the revenue cycle through bundled care, value-based care, and accountable care.
Accountable care is accomplished through great quality but also low-cost medical providers. The focus is to incentivize better quality of care through the means of reducing patient’s payment. Once a part of the Medicare payment model, more private insurance companies are turning toward this option (Lee, 2019). More and more medical facilities are leaning towards better patient centered care rather the number of services they can pile on a single patient. Increasing the quality care for the patient can decrease unnecessary services and waste of products as well as decreasing the chances of the patient being readmitted to the hospital. This can be tied into the value-based model that also is a replacement for the fee-for-service model.
Outpatient can also provide the patient the option of bundled payments. This model establishes payment up front for a set period of time reducing costs but upholding the quality of care (Sullivan et al., 2017). If a patient requires physical therapy and rehabilitation for a recent knee surgery, they utilize the bundled payment model at a fixed rate (Lee, 2019). \
Ethical Concerns
The struggle between focusing on the patient or finances and increasing unneeded services to account for longer time spent in inpatient care, are two major ethical concerns. Another one being with the bundled payment model, not providing a service since it may cost more than the bundled payment or opting to reserve not entirely necessary services or products since the patient may be paying more at the fixed rate than the total costs of the all the appropriate services. The dilemma of is the hospital satisfied in possible paying for the patient services or accepting the patient’s money after being essentially overcharged the total treatment plan. With fixed rates in the bundled plan, the hospital or the patient may be charged due to unforeseen charges. A possible way to combat this ethical concern is to have a rate that can fluctuate and to inform the patient about possible changes.
2. Adeshewa
As a staff member whose sole responsibility is to advance the success of the organization through assisting in planning, forecasting, and finance management it is important to identify how revenue cycle influences the building of the new hospital. The building of a new hospital is not an easy task It is very important for the management to know where they stand financially in order to not go out of their budget when in the process of building the building the hospitals. Revenue cycle influence the building of a hospital by helping the management to prioritize and provide quality services to patients.
It helps to bring financial viability and increase in quality services for patients. Providers are reimbursed for their services with the revenue cycle management. Once the patient calls and sets up an appointment till they make all they payments for their services, they cycle begins and ends. There are several steps in health care revenue cycle which are pre-authorization and eligibility verification; this is basically to ensure the patients insurance eligibility. Charge capturing and coding; This is the process by which the services rendered to patients are turned into coding and providers get reimbursed by insurance companies once the codes have been sent to them. Payment collection; the payment for the services collected by providers from patient. Medical service review; the identification and analyzing of errors throughout the services so providers can make improvement, lower the expenses so their revenue can be increase while still providing better quality of services to patients.
The reason why increased outpatient services will be required to improve revenue in a bundled care, accountable care, valued based environment it is less cost and they provide more preventive health services to patient. They are able to catch any illness at an early point and cure it before it becomes it gets chronic. This saves time, less expensive as patients do not like staying in hospitals for a long time and would not want to spend a lot of money on something that could be cured at an early point. Bundled payments encourage hospitals and other physicians to work together to improve the quality of care rendered to patients.
The 3 ethical concerns in the new billing environment would be confidentiality; providers have access to patients information so it is important to keep them private so patients know their information’s are in good hands.
Honesty: It is important for the providers to be honest with their patients throughout their time with hospital. They should kept in the loop and given accurate details on everything that involves them from the beginning an the end of their services.
Neutrality: Providers should not let anything get in the way of them attending to a patient. Some providers prefer certain insurance companies but that should not affect or get in the way of them treating a patient.
