Draft of Departmental Impact on Reimbursement

3-2 final project milestone one: draft of departmental impact on reimbursement
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* Reimbursement & the revenue cycle
What is reimbursement?
Reimbursement in healthcare refers to the sum of money received by hospitals, doctors, or other health providers from private health insurers or government agencies for health services offered to a patient. Once a patient gets treatment, the health provider makes a bill and sends it to the relevant institution depending on the patient’s health plan. Based on agreed-upon rates by the insurers, the health provider gets paid, and if the cover does not cover everything, a patient covers the rest of the bill (Casto, Forrestal, & American Health Information Management Association, 2013).
If services were offered to patients and no payment made, healthcare organizations would have to close down. The financial stability of a healthcare organization is what enables it to maintain its operation. As the primary source of income, reimbursements facilitate the payment of bills, procurement of supplies, payment of providers and employees to take care of patients effectively.
The flow of a patient through the revenue cycle
The revenue cycle consists of various steps a patient has to go through upon visiting a health facility. The first step is visiting the customer service desk for inquiries. Here, the patient undergoes pre-authorization, where they receive a medical form to fill in personal information and their medical history. The step is essential as it helps capture a patient’s data, which is vital for the revenue cycle and allows the patient to see how much their services will cost. Verification of the information is also done at the customer care desk to eliminate errors that may prove problematic down the cycle. The next step is receiving treatment. The step is essential as the patient sees a physician who examines them, orders additional tests if pertinent, and treats them for their ailment. If they require hospitalization, this is where it is determined. A patient also receives a prescription for their illness. The medical professional notes down the particulars on the patient’s encounter file. Finally, the patient visits the billing department. Here, their eligibility for a third-party payment of the bill is determined and communicated. Also, if the insurer is handling partial payment or the patient is paying out of pocket, they get an invoice and make the payments (Dobson, Pinker & Van Horn, 2009, p. 525-527).
In the revenue cycle, the most important department is the customer service department, where the pertinent information about a patient is collected, which begins the revenue cycle process. Then, the billing department follows as it determines the revenue an institution receives by ensuring every patient is billed for services offered. The coding department is third as it is crucial in coding medical information for making claims. The human resource department is next and is responsible for following up denied claims. The rest of the departments follow.
* Departmental impact on reimbursement
Impacts of departments that utilize reimbursement data
The...