Chat with us, powered by LiveChat Price Transparency Initiatives?Do they help the average American? (attached files are the screenshot of the book to help answer the questions) Many states and the federa - Writeedu

Price Transparency Initiatives?Do they help the average American? (attached files are the screenshot of the book to help answer the questions) Many states and the federa

 Price Transparency Initiatives—Do they help the average American? (attached files are the screenshot of the book to help answer the questions)

Many states and the federal government have price transparency regulations. The textbook provides examples from the Washington State Hospital Association and New Hampshire’s HealthCost. Search for additional price transparency examples and review the contents and information provided. After reviewing the sites, prepare an opinion paper (1 page APA format double-spaced).

  • Do you think price transparency initiatives help the average American better understand the cost and quality of the services at various hospitals?
  • Is there enough information to help a patient choose the best physician and hospital for treatment?

(the powerpoint attached is just a summary of the chapter, "price transparency part 1,2,3,4" is the pages of the book)

Principles of Healthcare Reimbursement and Revenue Cycle Management Chapter 9: Revenue Cycle Front-End Processes—Patient Engagement

Anne Casto, RHIA, CCS

Susan White, PhD, RHIA, CHDA

ahima.org

© 2021 AHIMA

ahima.org

Learning Objectives

Describe the processes included in the front- end of revenue cycle component

Analyze patient financial agreements

Explore the scheduling and registration process

Understand the impact of cost sharing on the patient’s financial position

© 2021 AHIMA

ahima.org

Revenue Cycle

Revenue cycle: regular set of tasks and activities that produce reimbursement

Revenue cycle management: the supervision of all the administrative and clinical functions that contribute to the capture, management, and collection of patient service reimbursement

© 2021 AHIMA

ahima.org

Front-End Processes

Patient Engagement

Middle Processes

Resource Tracking

Back-End Processes

Claims Production and Revenue Collection

Front-end Processes—Patient Engagement

Begins with the patient schedules services

Ends when the patient registers at the point of care

© 2021 AHIMA

ahima.org

Schedule services

Prior authorization (if required)

Registration

Financial counseling

Scheduling Services

Contact the healthcare provider

May schedule via a patient portal

Investigate cost sharing (out-of-pocket costs)

May receive pretreatment cost estimate from provider

Price transparency

Federal and/or state regulations require providers to make their standard or list prices available

Review figures 9.2 and 9.3 from textbook

Review example 9.1 from textbook

© 2021 AHIMA

ahima.org

Prior Authorization

P A Tips

Check P A requirements before providing services or sending prescriptions to the pharmacy

Establish a protocol to consistently document data required for P A in the medical record

Select the P A method that will be most efficient, given the particular situation and health plan’s P A options

Regularly follow-up to ensure timely P A approval

When a P A is inappropriately denied, submit an organized, concise, and well-articulated appeal with supporting clinical information

© 2021 AHIMA

ahima.org

Prior Authorization (P A)

P A is a process of obtaining approval from a health insurance company before receiving healthcare services

P A is a method of controlling the cost of care

Patient Intake

Patient registration

Collection of data

Patient’s medical history

Insurance coverage

Image of insurance card—stopgap to correct data entry errors

Agreement to fulfill financial obligations

Patient financial responsibility agreement

HIPAA authorization form

Advance beneficiary notification of noncoverage (A B N)

© 2021 AHIMA

ahima.org

Patient Financial Counseling

Healthcare payment plans

Healthcare loans

Payment support from manufacturers

Drug copay cards

Not available to patients with government-sponsored health insurance

© 2021 AHIMA

ahima.org

Patient Connection

Olivia’s husband, Tony, was prescribed a new drug for his asthma. The drug is not on the Super Payer formulary and therefore the copayment amount is 30 percent of the $3,110 price each month.

Olivia and Tony were able to locate information about a copay card that would reduce the copayment amount to $0 for the drug. 

© 2021 AHIMA

ahima.org

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