In human services, the revenue cycle is instrumental in promoting accountability and quality of services. Those receiving services can trace their payments to ensure that they are paying for the correct services. To institutions, financial management cycle allows the administrators to track all the expenditure and charges and the information is instrumental when determining the financial sustainability of the services offered. Also, the financial management system offers income recuperation and enhances the accountability of administrators to ensure that they adhere to the portfolio needs. The technology used in the system also allows the fast retrieval of data and also impromptu reporting at any given time.
Best Practices of Financial Management Systems
Analysts indicate that best practices can be challenging to characterize the dynamic nature of financial management systems. However, the baseline of such a system remains its ability to remain consistent when used in different settings. However, the financial management systems are regarded as perpetually symptomatic instruments that are dependent on the authenticity of the information fed to them. Therefore, just like technology, the integrity of the systems can be said to be determined by the accountability of the individuals using them (Cleverley & Cleverley, 2017). To ensure that a financial management system in healthcare serves the purpose of enabling the managers to comprehend how their institutions utilize the budgetary assets various aspects of best practice should be considered.
Delegate your assignment to our experts and they will do the rest.
Revenue/fee Scheduling
The revenue cycle depicts the efforts that an institution puts in place to gather a full installment for patients and the services that they receive. Best practices for the revenue cycle require that the therapeutic practices utilize a checklist to gather all the necessary data from the patients. The type of services or protection that the patient needs helps the scheduler to reorganize the type of data to be collected from the patients.
Charge Masters
In this form of income cycle, the cost capture is evident from the points that guarantee the experiences in an institution as well as the methods passed by the administrators. To incline to the provisions of best practice, there is a need to utilize the pre-numbered experience frames that include office visits and varied experiences by the patients (Cleverley & Cleverley, 2017).
Coding
In coding, the therapeutic approach must demonstrate the individuals or parties that are in charge of the process. The responsible persons should check the appropriate codes to be used in making conclusions and determining administration techniques (Langabeer & Helton, 2015). Best practices also provide that the individuals in charge of coding must receive progressive training on the emerging coding techniques and be exposed to the appropriate coding assets.
Claims Processing
The financial management systems utilize clearing houses to transmit cases of claim to different stakeholders in the health sector (Langabeer & Helton, 2015). The best practice in the industry provides for the payment posting which brings together all the involved stakeholders this allows the patients to assess the reports and determine their authenticity before being acted upon.
Denial Management
The denial management includes part of the financial cycle which brings little or no payment at all. The reasons for the disavowals may bring together inadequate base protection data, lack of pre-affirmation, lack of prior approval and blunders in the coding system. Best practice in denial management provides for the patterning and tracking of the refusals during the posting of installments (Ammar et al., 2013). The disavowals should be easily understood by the payers and the suppliers.
Information Technology Tools Analysis
The expanding obligation of the stakeholders requires the use of top notch technology that promotes accuracy and a traceable flow of payment and information. To enhance the patient experiences, an efficient financial management system computerizes, institutionalizes and streamlines the work processes by upgrading the pace and accuracy of the accumulated information. This is achieved through creating a trend and standard for healthcare statistics, maintaining an enterprise data warehouse, monitoring the financier contracts, and maintaining a touch with the clients.
The financial management systems have put in place different measures to improve these services received by the patients. First, technology in the form of electronic records has been an instrumental input in ensuring accuracy and fast retrieval of data. The technology has been crucial in ensuring that patient-specific data is stored and this reduces errors when making reimbursements. More importantly, the healthcare providers help to reduce the number claims that are denied by including the information in the revenue recycle management, particularly in the claims denials prevention system. This system assists in tracking the cases and pointing out the causative factors, the specific amounts denied and the individuals involved. The process brings different departments together including accounting, coding, case management, and compliance. The information is critical in determining the trends and identify patterns. Consequently, the stakeholders can assist the patients in identifying these factors and avoiding them during the subsequent service delivery (Cleverley & Cleverley, 2017). It is noteworthy that the quality of services and patient experience improves when there is lack of ambiguous information about the factors that contribute to claim denial.
The revenue management cycle also improves the patients experience through the adoption and integration of HER as provided by the HITECH Act. The facilities that offer Medicare and Medicaid programs are required to implement the HER technology and those that defy the provisions are liable to a fine (Adler-Milstein & Jha, 2017). The technology is critical in the streamlining of the coding and billing systems. Also when integrated with the patient accounting system, it has a significant effect on the hospital revenue cycle management. This has changed the way that claims are captured as well as the pre authorization procedures. Since more staff with the necessary skills are needed to implement the procedures; there is a consequent improvement in the services that the patients receive.
Decision Support
According to too feet al. (2015), an effective data archive corresponds to the requirement of capturing financial statements and presents them in varied layouts that are industry specific. This form of storage upholds accountability while at the same time making it easier for financial institutions such banks, insurance agencies among others to conduct investigations where there is need to determine financial processes.
In the decision support system, managers can provide the layouts of financial records, payment orders, and income explanations. According to the Institute of Financial Operations, it allows the stakeholders to upgrade their capacity to deal with the information that relates to their institutions through exploration, administration of systems and management of opportunities. Also, the parties involved in information capturing derive data on occasions, interfaces, and opportunities that can be explained over a range of monetary operations.
The data is numerically captured and introduced in the subtle financial statements. The instrumental parts of the financial statements include the financial records, pay proclamation, the demonstration of the changes experienced in the value of stakeholders, the description of money streams and the available and necessary commentaries. The financial history outlines the budgetary quality of an organization by demonstrating its assets and liabilities over a given period. The financial record, therefore, can regard as an image that depicts the actual position of an organization and the budgetary status within a given time.
Tracking of the financial data offers a crucial set of information about the income stream, the bill installments and well as the prediction money flows in the future. It is noteworthy that a business that does not appreciate financial tracking risk referring to and exploiting easy money while impairing its capacity to meet future obligations. Also, due to the overwhelming number of individuals seeking treatment services in the health institutions, there is a need for the health organizations to have accurate data for reimbursement purposes. It is also noteworthy that the people seeking services should not be burden by the ineffectiveness of the financial system especially where compensation is required. They assume that they should receive timely services and they have nothing to do with the internal systems and practices that are put in place by the organizations. The correct identification and tagging of cases using the relevant priorities such as date and urgency assists in avoiding cases on mix-ups and misplacement of crucial information. Research indicates that the cost of different services has been found to differ in different organizations due to case mix (Martin et al., 2011). To avoid this, there is a need to evaluate payer-specific data to provide a framework for equitable reimbursement and cost containment strategies.
The case mix and payment have become imperative particularly due to the vast number of people subscribing to Medicare and Medicaid. Comprehensive case mix information is arrived at through an analysis of the payer reports by evaluating their accurate accounts and correlating liaisons and referral sources with the different categories of the payers. This assists in achieving an optimum payer mix.
Conclusively, the revenue cycle management in healthcare has been instrumental in shaping the patient's experiences through the delivery of more accurate services that are founded on patient-specific data. The system has improved the services by the consumers through the adoption of technology such as the electronic records system which is critical in maintaining accurate information about the clients. Data is also captured from the patients and stored numerically in the system. In case of reimbursements, the cases of denial are well explained regars ofding the causative factors, and this helps to advise the patients with the objective of scaling down the cases. It is noteworthy that the dynamic nature of technology requires institutions to remain current by adopting the most efficient systems as well as training the personnel on how to exploit the technology. In doing so, they are in a position to operate within the best practices that are in line with the industry requirements as well as maintaining model internal best practices.
References
Adler-Milstein, J., & Jha, A. K. (2017). HITECH Act Drove Large Gains In Hospital Electronic Health Record Adoption. Health Affairs , 36 (8), 1416-1422.
Ammar, W., Khalife, J., El-Jardali, F., Romanos, J., Harb, H., Hamadeh, G., & Dimassi, H. (2013). Hospital accreditation, reimbursement and case mix: links and insights for contractual systems. BMC health services research , 13 (1), 505.
Cleverley, W. O., & Cleverley, J. O. (2017). Essentials of health care finance . Jones & Bartlett Learning.
Hopfe, M., Stucki, G., Marshall, R., Twomey, C. D., Üstün, T. B., & Prodinger, B. (2016). Capturing patients' needs in case mix: a systematic literature review on the value of adding functioning information in reimbursement systems. BMC health services research , 16 (1), 40.
Langabeer II, J. R., & Helton, J. (2015). Health care operations management . Jones & Bartlett Publishers.
Martin, S. G., Frick, A. P., & Shwartz, M. (2011). An analysis of hospital case mix, cost, and payment differences for Medicare, Medicaid, and blue cross plan patients using DRGs. The inquiry , 369-379.
