Perform Charge Reconcillation

Important responsibility of the MA is patient account (charge) reconciliation when …

reimbursements are made

EHR or Practice management system will automatically apply payments from third-party pater claims and record the payment to the what?

patient account, including contractual adjustment and any denied portion

What is Reconcilation ?

process of ensuring that the accounts are all balanced and accurate

Accounts must be accurate and recorded routinely to allow for what?

updated balances to be reflected, indicating any patient financial responsibility.

Patient receive statements indicating what?

charges and amounts paid and their final financial obligation that is due

Revenue Cycle for health care organization includes what?

all finance-related aspects

Who has a direct impact on the potential revenue that will be earned and collected?

the entire health care team

What are the parts of an effective revenue cycle?

patient records, documentation, coding and billing, claim submission, payment posting, and f/u

What contributes to healthy revenue cycle?

effective communication including with health care team, patients, and third party payers

What are Incentive Models part of ?

transition from strictly FFS (fee for service) to value-based programs

Incentive models include FFS reimbursement but have added …

incentives/disincentive based on provider preformance of achieving certain quality and clinical measures and providing patient satisfaction

Areas of concentration in Incentive Models include

preventive care and screenings, minimizing risks such as preventing hospital readmission, or other condition-specific measures that can improve overall health outcome of pt

Examples of Incentive models

Pay for Performance (P4P), Accountable Care Organizations (ACO), and Patient-Cenered Medical Home (PCMH)

Account receivables (A/R) for a health care organization include what?

any amount of money that is anticipated to be paid to it including medical services billed

An A?R aging report is used for what?

so that the older debts can be addressed first. Infomation can be used to identify potential collections from delinquent accounts.

Bank Deposits slips will need to be generated for what?

checks and cash received. Many financial transactions will occur with banking online

Third-party payers often use electronic transfers when

reimbursing for claims submitted electronically

What will help assist with keeping accurate records of the financial transactions?

EHR and practice management software

Health record auditing is done to ensure what?

documentation is complete, correct, and signed by the provider and that the details support codes reported for reimbursement and quality purposes

Internal audits

usually done within the health care organization by staff and often prospective audits meaning they are preformed prior to billing. It supports organizations compliance policy by supporting coding and billing accuracy

Prospective audits

support revenue cycle by ensuring that all services rendered are correctly billed.

When are retrospective reviews done?

after claims have been billed; audits that may be preformed internally for statistical/quality purposes/externally by a insurance company. Randomly chosen HR or targeted to specific data parameters

Concurrent review

audit preformed at inpatient facilities. Usually done during a pt stay to ensure documentation completeness and efficacy of tx