HIM 2133 Revenue Cycle and Billing Module 3 Assignment Prepare Insurance Claims for Submission
Rasmussen University HIM 2133 Revenue Cycle and Billing Module 3 Assignment Prepare Insurance Claims for Submission-Step-By-Step Guide
This guide will demonstrate how to complete the Rasmussen University HIM 2133 Revenue Cycle and Billing Module 3 Assignment Prepare Insurance Claims for Submission assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.
How to Research and Prepare for HIM 2133 Revenue Cycle and Billing Module 3 Assignment Prepare Insurance Claims for Submission
Whether one passes or fails an academic assignment such as the Rasmussen University HIM 2133 Revenue Cycle and Billing Module 3 Assignment Prepare Insurance Claims for Submission depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.
After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.
How to Write the Introduction for HIM 2133 Revenue Cycle and Billing Module 3 Assignment Prepare Insurance Claims for Submission
The introduction for the Rasmussen University HIM 2133 Revenue Cycle and Billing Module 3 Assignment Prepare Insurance Claims for Submission is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.
How to Write the Body for HIM 2133 Revenue Cycle and Billing Module 3 Assignment Prepare Insurance Claims for Submission
After the introduction, move into the main part of the HIM 2133 Revenue Cycle and Billing Module 3 Assignment Prepare Insurance Claims for Submission assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.
Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.
How to Write the Conclusion for HIM 2133 Revenue Cycle and Billing Module 3 Assignment Prepare Insurance Claims for Submission
After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.
How to Format the References List for HIM 2133 Revenue Cycle and Billing Module 3 Assignment Prepare Insurance Claims for Submission
The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.
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HIM 2133 Revenue Cycle and Billing
Module 3 Assignment
Prepare Insurance Claims for Submission
This assignment will provide you with insight into the use of data as it flows throughout the revenue cycle. Information gathered at the time of registration (demographics, insurance information, and admission date), charge capture throughout treatment and provision of services, the application of ICD-10, CPT, and HCPCs codes as well as provider information culminates in the claim form that is finalized and submitted for payment.
In this assignment, you will prepare two CMS-1500 and two UB-04 insurance claim forms using the data in four case scenarios.
To complete this assignment, do the following:
Download the zip file containing the four case scenarios below.
Case Scenarios
Download the CMS-1500 and UB-04 forms below.
CMS-1500 Form
UB-04 Form
Save two copies of each form on your computer (one for each of the two CMS-1500 scenarios and one for each of the two UB-04 scenarios). Save each form with a unique file name. Include the Case ID and form type in the file name (for example, CMS15001a, CMS15001b, UB2a, UB2b).
Download the instructions for completing the CMS-1500 and UB-04 forms below.
Instructions for Completing the CMS-1500 and UB-04 Forms
Using Adobe Acrobat Reader, enter the information from the case scenario into the appropriate field on the corresponding form. Refer to your readings for Physician and Hospital Medical Billing for information on CMS-1500 and UB-04 form locators and required information.
(If you do not have Adobe Acrobat Reader, download it from the Adobe website.)
For the CMS-1500 forms: Enter your name and date in the box in the upper left of the form. Enter the Case ID in the box in the upper right. Complete all pertinent fields #1-11d and 14-33 according to the data in the case and the guidelines you downloaded in Step 4.
For the UB-04 forms: Enter your name, the date, and the Case ID in the “Responsible Party” field (field 38) on the form. Complete all pertinent fields according to the data in the case and the guidelines you downloaded in Step 4.
Review and Assessment
The success of any healthcare institution is dependent on various aspects of systems working together. The revenue cycle management, which encompasses the billing system, depicts a crucial department that cannot be given a blind eye. Essentially, proper management of the financials of any healthcare organization determines whether or not it remains afloat. This essay, therefore, proposes a step by step account of the billing process, determination of the pricing structure, negotiating the insurance contracts, and handling of private pay and charity care.
The Revenue Cycle
To have the cycle functioning optimally, there should be an understanding that there is a need for system integration, which essentially combines all the electronic health records for the patient, billing, accounting, and collections. The cycle begins with sourcing for the appropriate RCM software. The software can be installed in the organization servers then managed by competent members from IT (Magray, 2016). On the other hand, it would be worthwhile to hire third-party experts to run the system if the organization expands the capacity to bring on board satellite affiliates to the institution.
Patient pre-authorization is then put in place, which in this case, efforts are made to ascertain if there are any doubts about the coverage. The necessity of the prescription, procedure, or service is determined in this step. In the next step, the eligibility and verification of the benefits are done, for instance, through secure channels with the help of a dedicated RCM software. Claims are then submitted in the next step, which is done automatically by using appropriate software.
Subsequently, payments are posted after successfully submitting the claim. The billing in this respect is done through the Electronic Data Interchange (EDI). Putting in place the appropriate denial management strategies is essential to keeping track of any claims that the insurer has turned down. The denial management helps to determine possible reasons for denial of honoring claims and therefore address them. Finally, working without reports would render operations futile. The software thus helps generate customized reports, detailing the management of information and the key performance indicators to determine whether or not the team is meeting targets.
Determining a Pricing Structure
The pricing structure settled on should be robust and straightforward at the same time. In this case, therefore, the market-oriented pricing structure should be explored. This option offers opportunities to capture a share of the market, create significant loyalty, increase demand through the utilization of economies of scale, and even stifle competitors out of the market. The strategy also confers some advantages in the long run. For instance, it can be combined with other pricing strategies to form a blend of more efficient pricing. It also offers an opportunity to increase the prices while at the same time monitoring competition. Further, this method helps to maintain operations to avoid being faced out by the competitors.
Several factors ought to be considered when determining the pricing structure for the healthcare organization. Competitors rank top as they determine whether the business could set prices independently or dependent on other healthcare organizations. The costs incurred in acquiring equipment and delivering services to the patients should also be factored in when pricing. There should also be a consideration of the state of the economy since people would be unwilling to spend when the economy is unfavorable, thus poor business.
Negotiating Insurance Contracts
Insurance plans are highly negotiable, and when doing so, there is a need to factor in some considerations. First, always consider the other party in the negotiations, determining what the payer is most concerned about, for instance, the ancillary services, then utilize them appropriately. Payers always look for cost controls and predictability, and therefore, the healthcare organization should be able to demonstrate that.
The availability of clinical data is also crucial since payers would need it as proof of compliance with clinical practice and disregard for unnecessary and expensive services. There is also a need to consider the contract language used since some payers demand prices that match public rates like Medicaid. Also, consider the appropriate authorization for the treatment course, the time frame allowed to file an appeal, and the period required to submit it. The relevant payer categories to consider would include both public and private. Important ones include Medicaid, BCBS, and Medicare.
Private Pay and Charity Care
The first undertaking when handling the private pay patients is to ensure the availability of a formal policy that is read to them to facilitate comprehension of obligation. The payment for the services by private option would be handled on a case by case basis. The private pay individuals would discuss with the presiding physician in advance regarding possible adjusted fee schedules. Later, there would be an arrangement for payment plans, like percentage charge, and the physician fee only limited the patient’s ability to pay. Before delivering the services, the patients should then sign promissory notes and make down payment in case of expensive procedures.
Regarding charity care, there ought to be guidelines and criteria definitions. Policies ought to be in place regarding the patients who suit to be considered for charity. Once determined, all medical professionals should be involved equally in rendering their services. Each of the cases should be rotated evenly to all the nurses and physicians assigned in every rotation order. The costs incurred in delivering charitable services are considered bad debts, collected, and then sent to the collection agency.
Web-based Billing Software System
QuickBooks software is appropriate billing software that offers acceptable standards in healthcare practice. It is capable of accepting business payments, carrying out the payroll functions, and managing and paying the bills (Stamper, Hartley, & Morrison, 2019). The software is also able to track the sales and profits, and it is capable of scheduling recurring payments, which saves time.
Benefits of the Changes to Physicians, Clinic, And Patients
When the RCM services provided are efficient, the physician has ample time to focus on improving healthcare services and improving the efficiency of the practice. Further, the physician’s revenue is also sustained since it is unlikely that losses would be imminent. The clinic stands to benefit significantly from streamlined operations since there would be more transparency and control over the financials. There are also reduced costs associated with the in-house operations and hence increasing the profitability of the clinic.
An efficient RCM allows for Account Receivables (A/R) reconciliation and hence follow-ups enabling the care providers to focus on delivering patient care. The clinic would also benefit in the sense that there are reduced billing errors when an appropriate software is in place; this goes a long way to build the reputation of any healthcare institution (Landman, 2016). A useful software impacts the patient because a lot of time is saved when verifying payments, and hence services are rendered fast.
When professional billing agents help in verification of all details like insurance compliance, patient enrolment, diagnosis, and treatment, there is little room for the occurrence of errors, and this increases the level of patient satisfaction. In the case of private patients, an efficient system protects them from incurring unnecessary expenses due to erroneous summations.
References
Landman, J. H. (2016). The value of behavioral health. Healthcare financial management : Journal of the Healthcare Financial Management Association, 70(12), 68–69.
Magray, N. (2016). SPORT FISHING, AN OPPORTUNITY FOR PROMOTION OF ADVENTURE TOURISM IN JAMMU AND \R\Nkashmir. International Journal in Management and Social Science, 4(11), 12. Retrieved from http://ijmr.net.in/currentijmss.php?p=VOLUME 4,ISSUE 11,November,2016
Stamper, J., Hartley, P. A., & Morrison, M. (2019). U.S. Patent No. 10,346,587. Washington, DC: U.S. Patent and Trademark Office.
ADDITIONAL INSTRUCTIONS FOR THE CLASS
Discussion Questions (DQ)
Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Read Also: HIM 2133 Revenue Cycle and Billing Module 4 Assignment Appeals Process
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.
Weekly Participation
Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality
Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes
I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.
LopesWrite Policy
For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy
The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication
Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.