HIMT 1250 Health Record Content- Revenue Cycle Management

HIMT 1250 Health Record Content- Revenue Cycle Management

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HIMT 1250 Health Record Content and Structure

Task

Revenue Cycle Management and Compliance 

Real-World Case 

David, a student from an accredited HIM program, was given a professional practice experience project that required him to review reimbursement denials for Medicare patients over the course of the past year. He noticed that the denials were higher when the claim included services from the radiology department. He researched the claims and resubmitted them with additional documentation. Through this process, he discovered that the additional d uments required were similar for each ci – Also, because of the settings on the org tion’s EHR, the required diagnosis codes f radiological services performed were not submitted on the claim form, although the pro-ced u re code was included on the claim_ David communicated his findings to the manager, and they discussed potential next steps. 

Answer the three questions in at least 250 words not including references

1. What could cause a denial from an insurance company?

2. Outline suggestions for process improvement to help improve efficiency of the revenue cycle management.

3. Which departments are responsible for the revenue cycle problems at this company? 

HIMT 1250 Health Record Content and Structure

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