C811 HIP TASK ONE Financial Resource Management – C811 Western Governors University (12pages)

A. There are six steps in the revenue cycle: provider services, document services, establish charges, prepare claim/bill, submit the claim, and receive payment. First step is providing services; this is when the services for the patient are provided. The medical record is formed as information is being collected from different departments and areas throughout the facility. Second step is document services. In document services all information that has been collected throughout the facility becomes vital. In 1996, HIPAA proposed the requirement of two coding methods to be used for all payors. These coding methods are referred to as ICD-10- CM and CPT/HCPCS codes. ICD-10-CM is diagnosis coding, where CPT/HCPCS is procedure coding. Both are required for the professional and facility side. This varies based on whether it is an inpatient or outpatient event or whether diagnosis or procedure affects the final reimbursement. Third step is stablishing charges. In establishing charges the chargemaster (CDM) comes into play. For every service, there is a unique cost. The CDM takes critical information that is required for the claim and the patient medical record and determines charges that will be placed on the claim. Vital information needed in the CDM includes a number unique to a specific charge, revenue cost, dollar value for the service, designated department number, and HCPCS/CPT code, if applicable (Casto & Forrestal, 2015). Fourth step is preparing the claim or bill. This step is where all charges found during a patient's encounter generate to a claim. There are usually two types of claims, CMS-1500 and