Hcr 220 Week 9 Rcm

RCM unifies the clinical and business side of healthcare using both primary and secondary patient data, insurance, and provider and the revenue cycle is vital in creating compliant and efficient reimbursement processes. The revenue cycle is divided into four which are preclaims activities, claims processing, account receivable and claims reconciliation and collection. The preclaims submission is the first process in the cycle which begins with patient case management and preregistration such as collection insurance information before patient arrives then collecting subsequent patient information to create a medical record number to meet financial, clinical and regulatory requirement and Medicare patient are advised on financial responsibilities if …show more content…
Coding is a major aspect of charge capture, and it requires ICD and/or HCPCS codes. And it is posted via the charge description master. The CDM is housed in the finance unit of the facility and the HIM department and CDM team work together to achieve quality services. The revenue cycle continues with coding by HIM and medical records are reviewed, identified and abstracted into the HIM system and afterward transferred into the patient account system where it is posted for claims prior to submission of payment. The data is reviewed by an internal auditor, and most facilities use an auditing system called scrubbers and this is used to check for error in each claim and it flags any error that can lead to denials or rejections of the claim. The final revenue cycle is the submission of claims payment where the providers must submit the claims no later than 12 months of the date of service. This also gives the providers an opportunity to address any challenges and questions from the