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CRCR Unit 1 (1.1 - 1.4) Rev Cycle in Healthcare 2024/2025 graded A+ by experts
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CRCR Unit 1 (1.1 - 1.4) Rev Cycle in Healthcare 2024/2025 graded A+ by experts
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CRCR Unit 1 (1.1 - 1.4) Rev Cycle inHealthcare
Patient-Centric Revenue Cycle - ANSThe major processing steps required for a request for
service through closing the account at zero balance.
Pre-Service - ANSScheduled & pre-registered pt.,cost est., data colleted
Time-Of-Service - ANSScheduled & Unscheduled-caser mgmt. & discharge, consents, pt is id'd,
copay & amt collected, pre reg record activated.Unsched pt have comprehensive regis &
financial processing
Post-Service - ANSAfter pt is discharged-bill to healthplan, pt account monitored until payment
reaches zero
Healthcare Dollars and Sense - ANSName given to the 3 HFMA revenue cycle initiatives:
Patient Financial Communications
Price Transparency
Medical Account Resolution
Patient financial communications best practices purpose & principles - ANS· All patient financial
interactions
· Emergency department
· Advance of service
· Time of service (outside the emergency department)
· Measurement criteria framework
Best Practices for price transparency - ANSAs part pf the consumer driven programs, patients
need pricing information to make informed healthcare choices in hospitals to inquire about costs
and fees prior to agreeing to service.
A. Required information for pricing include: type of hospital service (based on CPT/HCPCS or
MS-DRG code), patients' health plan and/or benefit plan
Medical account resolution - ANSEducate, bills, policies, consistency, coordinate, judgement,
timing, report and track
Financial Counseling - ANSIf appropriate, patient is referred to for financial assistance. Typically
patient share, prior balances, balance resolution
, Typical elements of financial discussions - ANSIncluding provision of care, registration,
insurance verification, and financial counseling (patient share, prior balances, balance
resolution)
Provision of care - ANSThe patient to make mutually acceptable payment arrangements to
resolve outstanding balance. Ability to pay will not interfere with treatment.
Balance resolution - ANSDiscussions may occur concerning prior balances that are being
handled by collection by provider, a collection of agency, or other organization
Price transparency - ANSOn Health Insurance Marketplace / Health Insurance Exchange have
consumer cost sharing requirement. Patients expect clarity & communication of costs, helps
consumers make smarter decisions about care received.
The need for Pricing Transparency - ANSPatients need pricing information, key info needed are
type of hospital service on CPT or MS-DRG code, patients health and benefit plans
Medical Account Resolution - ANSHFMA partnered with ACA (Association of Credit &
Collections) along with others to work on medical debt task force.
What are the Medical Account Resolution Best Practices - ANSEducate, bills, policies,
consistency, coordinate, judgement, timing, and report & track. (See diagram)
What option is NOT a main HFMA Healthcare Dollars and Sense revenue cycle initiative?
Medical account resolution
Process compliance
Price transparency
Patient financial communications - ANSProcess compliance
Patient Satisfaction Metric with in the Industry (HCAHPS)
Hospital Consumer Assessment of Healthcare Providers and Systems - ANSFrom patients
perspective, CMS implemented value based purchasing program that focus' on core measures,
one of which is HCAHPS. Objective is to provide a standardized method for evaluating patients'
perspective on hospital care.
CMS implementation of value-based purchasing - ANSHCAHPS
Objective of the HCAHPS initiative - ANSProvide a standardized method for evaluating patients'
perspective on hospital care.
HCAHPS Survey - ANS27 questions related to clinical care and patient engagement - one
question for all of satisfaction "Would you recommend this hospital to your friends or family?"
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