Module Four Activity Guidelines And Rubric
Healthcare administrators use various financial management tools for analyzing processes, mapping out performance objectives, reviewing case rates, and reviewing pay-for-performance incentives.
One of my responsibilities as an office administrator is ensuring that all billing codes are being used correctly. Using the wrong codes will delay my providers in receiving their payment by the payer. So, one thing that I could do is to conduct monthly charge description master, or CDM, reviews to make sure that billing codes are indeed being used correctly (Castro & Forrestail, 2015). Training and regular updates with my staff in regard to what billing codes are most frequently used, which codes may not be applicable, etc. would ensure effectiveness and a level of work with less errors for the office’s billing cycle.
Another important issue is to determine which claims receive priority. First and foremost, any claims that may be close to the end of when they can be submitted must be processed first, and then any claims rejected to be appealed before the cut off date. For example, some payers allow a provider up to 120 days to submit a claim to be approved and paid. If the provider fails to do this, the payer is not liable to pay the claim, nor is the patient. Secondly, if a claim was denied for the simple reason of using incorrect codes, this must be identified and resubmitted before the cut off date. I would say that I wouldn’t want to see any claims aging beyond the 90-day mark, and if there are any, it would be not that the payer did not pay, but that we are waiting on the patient to pay their portion, be it a co-pay, coinsurance, deductible, etc.
Castro, A. & Forrestail, E. (2015). Principles of healthcare reimbursement. (6th edition). AHIMA Press.
Use Google Spreadsheet or Microsoft Excel, along with what you have learned in Chapters 1 through 4, to chart, outline, or diagram at least three policies and/or processes that you, as a healthcare administrator, have determined need improvements. Examine the policies and/or processes that you identified within your discussion in Module Three for this activity. In order to gather three policies and/or processes, you will need to choose policies and/or processes that your classmates identified as well. Then, organize these three policies and/or processes, as well as your justification for selecting each You may use the Module Four Activity Template for this assignment, but using the template is not required.
Upload your chart as an XLS file (Excel or Google Spreadsheet or equivalent).
Overview: Healthcare administrators use various financial management tools for analyzing processes, mapping out performance objectives, reviewing case rates, and reviewing pay-for-performance incentives. Prompt: Use Google Spreadsheet or Microsoft Excel to chart, outline, or diagram at least three policies and/or processes that you, as a healthcare administrator, have determined need improvements. Examine the policies and/or processes that you identified within your discussion in Module Three for this activity. In order to gather three policies and/or processes, you will need to analyze policies and/or processes that your classmates identified as well. Then, organize these three policies and/or processes, as well as your justification for selecting each. You may use the Module Four Activity Template for this assignment, but using the template is not required.