Revenue Cycle Management

According to one author, revenue cycle management in healthcare is the process of managing your office’s claims processing, and revenue generation (What is, 2014). It is important to have an efficient process to prevent loss of revenue from rejected claims and unpaid medical bills (What is, 2014). Some reasons we don’t have manage the cycle well is poorly trained staff, lack of communication between staff, and poor workflow (What is, 2014). Management decisions to improve the revenue cycle is the topic of this unit’s discussion question.

1. What is revenue cycle management and why is it important? (2014). Retrieved from
Unit Learning Outcomes
ULO 1: Explain the revenue management cycle (CLO 2 and 6).

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ULO 2: Identify and discuss techniques to improve the revenue management cycle (CLO 2 and 6).

Initial Posting
For this week’s discussion question, you will explore the revenue management cycle. You have recently been hired as the VP of Revenue Cycle Management for Happy Valley Regional Health System in Winston Salem, NC. The system is consisting of an academic medical center, two community hospitals and 24 outpatient primary and specialty clinics. The hospitals have annually: 50,000 admissions, 75,000 ER visits, 900,000 outpatient encounters, and 1.3 million clinic visits. You have been tasked by the director to improve the revenue cycle process. Some issues that you have identified with the current process:

1. Failure to get insurance verification
2. Failure to get insurance information
3. Ordering services that are not preauthorized
4. Performing medically unnecessary services
5. Submitting charges after the allowed documentation period
6. Improper matching entries with charge-master file
7. Documentation and coding errors
8. Lag times in coding
9. Failure to follow specific billing rules
10. Mishandling of insurer payment denials
11. Posting errors that mis-state the remaining outstanding patient balances
You will prepare a memorandum for the facility director with your recommendations to improve the process. Make sure that you provide some discussion on the actual revenue management cycle. Also include some discussion on how these improvements can save the organization money and increase its revenue. Provide some discussion on how you will gain employee buy-in with regard to the changes.

The initial posting should be prepared as a Microsoft™ Word document, and then attached to the unit discussion thread. There is no minimum or maximum in terms of the word count; however, the response should explicitly address all required components of this discussion assignment. The document should be prepared as a practical business deliverable (single-spaced) and reflect higher-level cognitive processing (analysis, synthesis, and evaluation).

Support the initial posting with at least 3 references of credible or peer-reviewed sources. The in-text citations and the list of references should be consistent with the APA writing style (7th ed.). To earn the maximum number of points for the initial posting, the overall quality of the writing should be consistent with that expected of a college student and industry professional.

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