Introduction
The revenue Cycle helps in managing the billing policies and procedures of an organization. Various steps are involved in this cycle including pre-verifying of insurance, a charge capture system, coding of services, ensuring accurate and timely charge entry, payment posting and managing accounts receivable. Meanwhile when it comes to insurance negotiations, the provider and client can choose to come to an agreement. Additionally, one needs to pay considerations when it comes to charity care and private pay.
Revenue Cycle
Steps in the revenue cycle start with pre-verifying of insurance. In this stage, each client should have a copy of their insurance card forwarded to the organization for verification of their information. The next stage involves having a charge capture system that records all encounters, services and procedures taking place. From there the next stage will involve coding of services and procedures while those assigned with that task must be granted access to various resources and educated on the coding. The next stage involves ensuring accurate and timely charge entry process. This process should be able to verify insurance numbers and demographic information. The next stage involves payment posting through electronic remittance such that fee schedules and payer contracts are inbuilt to the system for accuracy. The last step involves managing accounts receivable through following a credit policy, establishing sales terms in addition to having a system that tracks accounts receivables. Moreover, traditional ratios should be used to assist in measuring the number of times receivables have been converted to cash while they need to be modified to account for the many fluctuations in the cycle of sales.
Pricing Structure and Insurance Contracts
The pricing structure of any organization plays a critical role in ensuring the effectiveness of marketing a company. The most suitable method would be the Boston Matrix that looks into product portfolio against the axis of market growth and market share. This plot helps a business to determine where its services and products fall. Therefore these strategies help in increasing share, maximizing share, stimulating a market share and maintaining share. The actions taken next would depend on the market share of the company and on whether the market is growing. Therefore, the premium pricing ought to take advantage of the positioning to maximize profits. Alternatively, if a low market share is experienced in a region of fast growing market, then measures to generate share ought to be taken in order to penetrate the market. This can be done through setting lower prices than competitors and once the share has been established the prices can be adjusted upwards for maximum profits.
The negotiation for insurance contracts can be a very tiresome and lengthy process for the provider. This is because they may lack the personnel and resources to draft comprehensively. Moreover, they may lack leverage of bringing to the negotiating table. However, the provider and his operational personnel ought to review each contract carefully. The Payor entities can agree on modifications following strong rationale of accommodating provider’s internal operations and law requirements.
Considerations of charity care involve that of financial challenges as donors may decide to fund less. Moreover, demand for these programs may not decline but experience a population shift. Additionally, determining the eligibility of applicants may pose a challenge. Private pay involves long term insurances that are not paid for by the government. Meanwhile the considerations for private pay may include the maximum benefits of policies offered, the elimination period and whether services of home health care are provided. One should also consider the cost of the insurance policy as each company offers its own rates.
Conclusion
Therefore, the revenue cycle helps in managing the billing policies and procedures of an organization. Various steps are involve in this cycle with the first being that of pre-verifying insurance. The next stage involves having a charge capture system that records all encounters, services and procedures taking place. From there the next stage will involve coding of services and procedures while the next next stage involves ensuring accurate and timely charge entry process. The other stage involves payment posting through electronic remittance such that fee schedules and payer contracts are inbuilt to the system for accuracy. The last step involves managing accounts receivable through following a credit policy, establishing sales terms in addition to having a system that tracks accounts receivables. The pricing structure of any organization plays a critical role in ensuring the effectiveness of marketing a company. The most suitable method would be the Boston Matrix that looks into product portfolio against the axis of market growth and market share. The negotiation for insurance contracts can be a very tiresome and lengthy process for the provider. The Payor entities can agree on modifications following strong rationale of accommodating provider’s internal operations and law requirements. Considerations of charity care involve that of financial challenges as donors may decide to fund less. Considerations of charity care involve that of financial challenges as donors may decide to fund less. Meanwhile the considerations for private pay may include the maximum benefits of policies offered, the elimination period and whether services of home health care are provided. Having laid down the policies to follow then management becomes efficient.
References
Arville, A. (28, March 2011). Important Considerations in Negotiating a Managed Care Contract. Retrieved from Ober Kaler: http://www.ober.com/publications/1434-important-considerations-negotiating-managNed-care-contract-provider-perspective
