A. There are six steps in the revenue cycle: provider services, document services,
establish charges, prepare claim/bill, submit the claim, and receive payment. First step is
providing services; this is when the services for the patient are provided. The medical record is
formed as information is being collected from different departments and areas throughout the
facility.
Second step is document services. In document services all information that has been
collected throughout the facility becomes vital. In 1996, HIPAA proposed the requirement of
two coding methods to be used for all payors. These coding methods are referred to as ICD-10-
CM and CPT/HCPCS codes. ICD-10-CM is diagnosis coding, where CPT/HCPCS is procedure
coding. Both are required for the professional and facility side. This varies based on whether it is
an inpatient or outpatient event or whether diagnosis or procedure affects the final
reimbursement.
Third step is stablishing charges. In establishing charges the chargemaster (CDM)
comes into play. For every service, there is a unique cost. The CDM takes critical
information that is required for the claim and the patient medical record and determines
charges that will be placed on the claim. Vital information needed in the CDM includes a
number unique to a specific charge, revenue cost, dollar value for the service, designated
department number, and HCPCS/CPT code, if applicable (Casto & Forrestal, 2015).
Fourth step is preparing the claim or bill. This step is where all charges found during a
patient's encounter generate to a claim. There are usually two types of claims, CMS-1500 and
Category | Exams and Certifications |
Comments | 0 |
Rating | |
Sales | 0 |