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Published byThomas Chapman Modified over 9 years ago
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Revenue cycle operations There are three functional areas in the revenue cycle (improve revenue cycle): front end, middle, and back end.
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FRONT-END PROCESSES Pre-registration Scheduling Patient Access and Registration Pre-authorization, Pre-certification, and Insurance Verification. Point-of-Service Collections and Financial Counseling.
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MIDDLE PROCESSES Clinical Documentation/Medical Records. Charge Capture and Coding. Charge Master and Master Patient Index. Late Charge Reductions. Case Management.
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BACK-END PROCESSES Billing: Primary and Secondary Insurance. Reimbursement, Posting, Refunds, and Adjustments. Follow-Up/Tracking. Denial Management. Bad Debt and Collections. Customer Service: Front, Middle, and End Processes. Management Expectations.
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Quality measurements and metrics are important elements in the evaluation cycle, especially related to process improvement, for several reasons: Metrics support the analysis, recommendations, and conclusions—you cannot argue with quantifiable data. Metrics establish the tone where both negative and positive outcomes are measured. Metrics provide a mechanism for understanding outcomes and a way to obtain employee buy-in to change.
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Metrics establish accountability, especially for those employees not performing to par. Metrics provide data to leadership, enabling them to focus of issues, problems, and resolutions. Metrics are also used as a means to celebrate improvement once attained.
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