PARKS, REVENUE CYCLE FOR HEALTHCARE, 1E, 9780357625514; CHAPTER 1: OVERVIEW OF REVENUE

Solution and Answer GuideParks, Revenue Cycle for Healthcare, 1e, 9780357625514; Chapter 1: Overview of Revenue Cycle Managem ent 1 © 2024 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.Solution and Answer Guide

PARKS, REVENUE CYCLE FOR HEALTHCARE, 1E, 9780357625514; CHAPTER 1: OVERVIEW OF REVENUE

CYCLE MANAGEMENT

TABLE OF CONTENTS

Check Your Understanding: Remittance Advice ................................................................ 1 Enrichment activity: Interview ........................................................................................... 1 Enrichment activity: Careers .............................................................................................. 1 End of Chapter Review ....................................................................................................... 2

CHECK YOUR UNDERSTANDING: REMITTANCE ADVICE

Review the remittance advice in Figure 1-7 to familiarize yourself with its organization and legend. Identify the most likely reason why patient Lynch was not charged for coinsurance.

Answer: The billed amount is the same as the allowed amount agreed to by the

payer, therefore there is no coinsurance due. Suggestion: This question can be used by the instructor to open a discussion about remittance advice and explanation of benefits.

ENRICHMENT ACTIVITY: INTERVIEW

Interview an insurance specialist whose task is to monitor claims status within the

billing department of a health care facility. Ask these questions:

• What is their procedure for monitoring the claims process?• What AI software do they use to track the status of claims?• Can they identify the number of claims that are returned because of errors?

Answer: Answers will vary.

ENRICHMENT ACTIVITY: CAREERS

Go to https://ahima.org/careermap and explore the emerging careers in revenue cycle management that are available to you. Choose one and explain what the job is, what technology you anticipate working with, what education level you need to perform that job, and why that job appeals to you. 1 / 4

Solution and Answer GuideParks, Revenue Cycle for Healthcare, 1e, 9780357625514; Chapter 1: Overview of Revenue Cycle Managem ent 2 © 2024 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Answer: Answers will vary based on individual student interest.

END OF CHAPTER REVIEW

• Explain the goals of the claims adjudication process performed by the payer.

Answer: Verify the claim is not a duplicate submission, verify the service provided is a covered benefit, verify deductibles, copays and coinsurances as outlined on the patient’s plan.

• What is the significance of a clean claim? In your answer, forecast the ramifications of

errors.Answer: A clean claim is one that is free of errors, both demographic, coding and completeness of claim documentation. Claims returned because of errors or omissions slow the reimbursement to the provider and thus impact the financial viability of the facility.

• Differentiate deductible, copay, and coinsurance. Why is it important for the provider and

the patient to know the difference?Answer: The deductible is an amount for which the patient is financially responsible before the insurance policy provides coverage. Coinsurance is the percentage the patient pays for covered services after the deductible has been met and the copay has been paid.The copay is the specific dollar amount the patient is required to pay to a heath care provider for each visit or medical service received, as stated in the insurance policy.

• Summarize the significance of a managed care contract to the way health care is delivered

today.Answer: Contracts are legally binding and describe the obligations of the providers and payers in providing healthcare services to patients who are insurance plan members/beneficiaries. This contract includes how the claims are to be submitted, medical necessity determination, any contract exclusions, per diem arrangements, predefined fee schedules, and capitation. The provider agrees to accept, in full, the payment established in the contract. A fee schedule is included that lists what the insurance company will pay for each provided service or supply. The contract, in turn, gives the payer access to confidential patient records.

• Map the steps in the revenue cycle, explaining which department/personnel are

responsible for each step.Answer: Answers may be a graph, table or narrative but should demonstrate the student’s understanding of each step

• Choose any step in the revenue cycle and recommend a procedure to ensure compliance

with HIPAA Privacy and Security Rules.

Answer: Answers will vary.

• Assess how the use of technology makes the revenue cycle more efficient.

Answer: Answers will vary depending on which technology the student addresses or if they compare all possible uses of technology. 2 / 4

Solution and Answer GuideParks, Revenue Cycle for Healthcare, 1e, 9780357625514; Chapter 1: Overview of Revenue Cycle Managem ent 3 © 2024 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

• Compare how the various Security Rule safeguards protect ePHI.

Answer: Answers will vary but should include discussions of all three safeguards: administrative, technical and physical. 3 / 4

Solution and Answer GuideParks, Revenue Cycle for Healthcare, 1e, 9780357625514; Chapter 2: Reimbursement Processes and Tools 1 © 2024 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.Solution and Answer Guide

PARKS, REVENUE CYCLE FOR HEALTHCARE, 1E, 9780357625514; CHAPTER 2: REIMBURSEMENT

PROCESSES AND TOOLS

TABLE OF CONTENTS

Check your understanding: MCOs ...................................................................................... 1 Check your understanding: Utilization Review and Case Management .......................... 2 Enrichment Activity: Revenue Cycle as Part of Health Care Finance ............................. 3 Enrichment Activity: Managed Care Plans ........................................................................ 3 Enrichment Activity: PAR and nonPAR physicians ........................................................... 3 Enrichment Activity: Effects of the ACA ........................................................................... 4 Enrichment Activity: Understanding CAC ......................................................................... 4 End of Chapter Review ....................................................................................................... 4

CHECK YOUR UNDERSTANDING: MCOS

• Which of the following provides a list of services and the amount that an

insurance company will pay for each service?

• Capitation
• Fee schedule
• Point of service plan

Answer: Fee schedule

• Which of the following are MCOs? Select all that apply.
• HMO
• POS
• PPO
• PCP

Answer: HMO, PPO

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