Data collection of patient's insurance information
4
Approval: Patient Insurance Information
5
Prepare initial bill
6
Check eligibility and authorizations
7
Submitting the bill to the payer
8
Posting payments
9
Approval: Payment Posting
10
Prepare secondary insurance bill if needed
11
Follow up on unpaid bills
12
Patient Responsibility Collection
13
Denial Management
14
Approval: Denial Management
15
Creating a patient statement in case of any outstanding balance
16
Audit the billing process
17
Approval: Audit Report
18
Report Generation
19
Revenue Collection
Patient Admission
This task involves admitting the patient into the hospital system. It is essential for creating a comprehensive record and starting the revenue cycle management process. The desired result is a successfully admitted patient with accurate demographic details. How can we ensure a smooth admission process for the patient? What challenges may arise and how can they be resolved? What resources or tools are required for this task?
1
Male
2
Female
3
Other
Coding Diagnosis and Procedures
In this task, the medical codes for the patient's diagnosis and procedures are assigned. Accurate coding is crucial for proper billing and reimbursement. The desired result is correctly assigned codes that reflect the patient's condition and treatment. How can we ensure accurate coding? What challenges may arise and how can they be resolved? Are there any specific resources or tools required for this task?
Data collection of patient's insurance information
This task involves collecting the patient's insurance information to facilitate billing and claims processing. The desired result is accurate insurance details for the patient. How can we collect and verify insurance information effectively? What challenges may arise and how can they be resolved? Are there any specific resources or tools required?
Approval: Patient Insurance Information
Will be submitted for approval:
Data collection of patient's insurance information
Will be submitted
Prepare initial bill
This task involves preparing the initial bill for the provided medical services. The desired result is an accurate and detailed bill that reflects the patient's treatment. How can we ensure the accuracy of the bill? What challenges may arise and how can they be resolved? What resources or tools are required for this task?
Check eligibility and authorizations
In this task, the eligibility of insurance coverage and any required authorizations are verified. It is essential to ensure that the provided services are covered by the patient's insurance policy. The desired result is verified eligibility and authorizations. How can we efficiently verify eligibility and obtain necessary authorizations? What challenges may arise and how can they be resolved? Are there any specific resources or tools required for this task?
1
In-Network
2
Out-of-Network
3
Not Covered
Submitting the bill to the payer
This task involves submitting the bill to the payer, such as an insurance company or government program. The desired result is timely bill submission for reimbursement. How can we ensure the smooth submission of bills? What challenges may arise and how can they be resolved? Are there any specific resources or tools required for this task?
Posting payments
In this task, the received payments from the payer are recorded and posted in the system. The desired result is accurate and up-to-date payment records. How can we efficiently record and post payments? What challenges may arise and how can they be resolved? Are there any specific resources or tools required for this task?
Approval: Payment Posting
Will be submitted for approval:
Posting payments
Will be submitted
Prepare secondary insurance bill if needed
If the patient has secondary insurance coverage, this task involves preparing a bill for the secondary insurance payer. The desired result is an accurately prepared secondary insurance bill for reimbursement. How can we efficiently determine the need for a secondary insurance bill and prepare it accurately? What challenges may arise and how can they be resolved? Are there any specific resources or tools required for this task?
1
Yes
2
No
Follow up on unpaid bills
In this task, unpaid bills are followed up to ensure timely payment. The desired result is improved cash flow by minimizing long overdue bills. How can we effectively follow up on unpaid bills? What challenges may arise and how can they be resolved? Are there any specific resources or tools required for this task?
1
Send Reminder Letter
2
Make Phone Call
3
Send Email
Patient Responsibility Collection
In this task, the patient's portion of the bill is collected directly from the patient. The desired result is prompt and accurate collection of patient responsibility. How can we streamline the patient responsibility collection process? What challenges may arise and how can they be resolved? Are there any specific resources or tools required for this task?
Denial Management
This task involves managing and resolving denied claims or reimbursement rejections. The desired result is minimized claim denials and maximized reimbursement. How can we effectively handle denial management? What challenges may arise and how can they be resolved? Are there any specific resources or tools required for this task?
Approval: Denial Management
Will be submitted for approval:
Denial Management
Will be submitted
Creating a patient statement in case of any outstanding balance
If the patient has an outstanding balance, this task involves creating a patient statement for the balance due. The desired result is an accurate patient statement that reflects the outstanding balance. How can we efficiently create patient statements for outstanding balances? What challenges may arise and how can they be resolved? Are there any specific resources or tools required for this task?
Audit the billing process
In this task, the billing process is audited to ensure compliance and accuracy. The desired result is a comprehensive audit report that identifies any discrepancies or errors. How can we effectively audit the billing process? What challenges may arise and how can they be resolved? Are there any specific resources or tools required for this task?
1
Internal Audit
2
External Audit
Approval: Audit Report
Will be submitted for approval:
Audit the billing process
Will be submitted
Report Generation
This task involves generating reports related to the hospital revenue cycle management process. The desired result is informative and actionable reports that provide insights into the financial performance. How can we generate comprehensive and insightful reports? What challenges may arise and how can they be resolved? Are there any specific resources or tools required for this task?
1
Financial Performance Report
2
Claims Analysis Report
Revenue Collection
In this final task, the collected revenue and payments are reconciled to ensure accuracy and completeness. The desired result is successfully reconciled revenue records. How can we effectively reconcile revenue collection? What challenges may arise and how can they be resolved? Are there any specific resources or tools required for this task?
