Prepare a revenue cycle plan for a community hospital.  Include the following information in your plan:

• Introduction
• Evaluation of clinical data required for payment and reimbursement systems (PPS, DRG, RBRVS, RUGs, VBP, Billing/insurance plans).
• Explanation of chargemaster and claims management applications and processes.
• Assess effect on healthcare finance of revenue management (cost reporting, budget variances).
• Summarize revenue cycle management and reporting processes (CCI, X12N).
• Evaluation of severity of illness and how it impacts the healthcare payment systems.

The format of this plan is like a policy and procedure but is a longer document. Compile your document based on the findings and collection of information for each of the requirements.

Grading Criteria

Assignment 2: Revenue Cycle Plan

Points

Plan includes an evaluation of: Clinical data required for payment and reimbursement systems (PPS, DRG, RBRVS, RUGs, VBP, Billing/insurance plans

15

Plan includes explanation of: Chargemaster and claims management applications and processes.

15

Plan includes assesses: Effect on healthcare finance of revenue management (cost reporting, budget variances).

15

Plan includes summary of: Revenue cycle management and reporting processes (CCI, X12N).

20

Plan includes evaluation of: Severity of illness and how it impacts the healthcare payment systems.

15

Plan is comprehensive and written in a policy and procedure format, based on findings and collection of information

20

Total

100 points

This assignment will assess the following CAHIIM Competencies:

Domain IV. Revenue Cycle

          Subdomain IV.A. Revenue Cycle and Reimbursement

1. Manage the use of clinical data required by various payment and reimbursement systems
2. Take part in selection and development of applications and processes for chargemaster and claims management.
3. Apply principles of healthcare finance for revenue management.
4. Implement processes for revenue cycle management and reporting.

Domain V. Compliance

          Subdomain V.B. Coding

1. Identify severity of illness and its impact on healthcare payment systems.