Topic 1: Interrelationship between the Revenue Cycle and Reimbursement
The revenue cycle is referred to as "all clinical and administrative roles that contribute to the capture, organization, and collection of patient service revenue” (Casto & Forrestal, 2013) . With the correct execution of all these processes, the revenue cycle has predictable performance. The revenue cycle is one of the most vital processes in the processes of finance in any healthcare organization ( Casto & Forrestal, 2013) . At the point of encounter, the initial financial information of the patient such as their insurance is collected as well as partial payment. Charges for the procedures and services offered to the patient are also processed and added to the patient's bill- claims processing. The costs accumulate and are then filed and presented to the patient for payment or reimbursement ( Casto & Forrestal, 2013) . Before the claims are submitted, codes ought to be used to the encounter with the patient. Guidelines by the health information system personnel trained in coding determine the codes used. There ought to be an immediate order for payments to ensure timely reimbursements.
Reimbursements are the key contributors to the flow of cash within the healthcare organization ( Casto & Forrestal, 2013) . Cash is very vital in the sustainability of the organization as well as driving forward the operations of the organization. The revenue cycle is a continuous process that only stops when the billing of patients is at a zero balance.
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Topic 2: Pay for Performance and Attention to Details
Pay for performance by definition is the rewarding of healthcare providers who provide effective and efficient services that are considered to have exceeded the standard quality but at a lower cost. It is also known as merit pay or incentive pay (Bardach et al., 2013). It encourages value-based care while still utilizing the fee for service system. It ties payments to outcomes that are metric driven, based on patient satisfaction and use of proven best practices (Caveney, 2016). There are two types of pay for performance in hospitals. The first one involves the payers reducing the overall FFS payments and giving the collected cash to give rewards to hospitals that offer quality, effective and efficient services (Bardach et al., 2013). The second type is where the hospitals with sub-optimal service provision are penalized with the penalties directed to save costs directly for the payers or use it to have the cash to give incentives.
Attention to detail is one of the qualities needed for any great healthcare professional. An individual can focus on an activity, task or person. People who can pay attention to detail perform better in their workplace and the tasks they are given to complete (Caveney, 2016). Excellent organizational skills, time management skills, analytical thinking, observational skills, and active listening skills are some of the abilities in people who have great attention to detail (Bardach et al., 2013). In healthcare, quality service is more likely to be given by staff that pay greater attention to detail and hence a greater pay for performance.
Topic 3: Claims Processing and Reimbursement
Reimbursement is the repayment of someone or a healthcare organization in the case of healthcare. The healthcare organizations receive rebates from insurance companies or third parties. Claims' processing, on the other hand, is the processing of the charges to be paid (Keagy, Thomas, & eds, 2012). The healthcare sector payers are the government and other commercial payers. There are two most significant contributors to healthcare, they include, Medicare and Medicaid. There are four segments of health service provision in Medicare; for example, they are supplies, employment, drugs administered and services offered (Keagy, Thomas, & eds, 2012). There is a reduced cost of all prescription offered by Medicare. As a coder in the medical profession, integrity is key as well as effectiveness and efficiency in the claims processing (Keagy, Thomas, & eds, 2012). Overbilling puts a strain on the patient-institution relationship, therefore, leading to adverse outcomes in staff and patient financial wellbeing.
References
Bardach, N. S., Wang, J. J., De Leon, S. F., Shih, S. C., Boscardin, W. J., Goldman, L. E., & Dudley, R. A. (2013). Effect of pay-for-performance incentives on quality of care in small practices with electronic health records: a randomized trial. JAMA , 310(10), 1051-1059.
Casto, A. B., & Forrestal, E. (2013). Principles of healthcare reimbursement . American Health Information Management Association.
Caveney, B. J. (2016). Pay-for-Performance Incentives Holy Grail or Sippy Cup? North Carolina Medical Journal, 77(4), 265-268.
Keagy, A., B., Thomas, M. S., & eds. (2012). Essentials of physician practice management (Vol. 6). John Wiley & Sons
