Imagine that you are the Revenue Cycle Manager and Independence Hospital. You are asked to provide an analysis of the current reimbursement processes and their effect on financial management decisions.
You are asked to perform an analysis of cash flow based on a key element of the revenue cycle- claims processing. Cash flow is the cycle of receiving and disbursing cash payments. When there is positive cash flow, there is more cash received than disbursed. This is important to healthcare providers because cash results from clean claims. The chief financial officer (CFO) has discovered that there may be some cash flow and reimbursement issues, based on claims submissions. Your next task is to compile a report to the CFO, to examine cash-flow issues relevant to reimbursement of providers; and to outline potential reimbursement issues.
In a 2- page report, assess types of cash flow and reimbursement issues:
Cash Flow Issues
Explain cash-flow issues relevant to reimbursement of providers.
Compare the risks to payer and provider of each reimbursement methodology.
Examine the concept of positive cash flow in relation to claims processing.
Reimbursement issues
Explain timely payment, with examples.
Describe recoupment, with examples.
Examine the concept of difficult economics in relation to a healthcare provider