2-2 Final Project Milestone One: Identify Organizational Problem
Begin by identifying an organizational problem within your own workplace healthcare setting or a hypothetical healthcare organization. If you choose a problem
in your workplace, be sure to utilize data from that healthcare organization; if you have created a hypothetical healthcare organization, you may use a public
domain database with instructor permission. As this is a scholarly initiative, this assignment must adhere to all APA requirements and formatting, and include
peer-reviewed and evidence-based sources to support any and all claims. As you develop this first part of the assignment, consider the following prompts to
formulate your paper.
I. What Is the Organizational Problem?
A. Provide a contextual basis for the organizational problem that you have chosen. How does this problem fail to meet quality or other regulatory
requirements?
B. Articulate organizational challenges posed by the problem (e.g., interdepartmental conflicts, communication failure, budgeting issues).
II. Evidence-Based Support
A. Provide data that supports the existence of the problem. You may utilize public sources to find data related to your selected problem.
B. How has this problem been addressed in the past? What information management systems or patient care technologies have been utilized when
addressing this problem? Be sure to use peer-reviewed literature to support your answer.
C. Discuss relevant accreditation standards, safety standards, compliance standards, and quality initiatives. How do these standards promote a
culture of safety within the department? Be sure to cite the appropriate standards within your answer.
Guidelines for Submission: This paper should be one to two pages in length, not including the cover page or reference page. Use APA format for the reference list
and all internal citations.
Final Project Milestone One: Identify Organizational Problem
Name
Institution
Date
Overview of the Identified problem
The efficiency of medical practice billing processes has a critical impact on the organization's financial performance. Health care organization revenue is generated by treating patients and collecting claims from insurance companies with other patients paying directly for the services (Casto & Forrestal, 2013). It is imperative that patient's records capture patient information because the information is sent to the patient insurance company or billed correctly for patients to pay cash (Singh & Wheeler, 2012).
If the health care facilities do not receive payment for their service, it is because the patient is not an eligible beneficiary of a health care plan, keeping track of all patients eligible for a health care plan can be difficult (Singh & Wheeler, 2012).Healthcare facilities run into loses due to rejected claims , that is why the relationship between the revenue cycle and the reimbursement process needs to be efficient.
Background of the problem
The healthcare revenue cycle management is a key financial process for health care facilities; it is an integrated process that combines administrative and clinical functions related to claims processing, payment and revenue collection (Wager, Lee & Glaser, 2017). Apart from tracking patient claims, revenue cycle includes all the process starting with the appointment process up to the time a patient leaves the hospital. Important tasks like coding, charge capture, claim submission, payment posting, statement processing and managing denied claims are all important process of the cycle(Wager, Lee & Glaser, 2017).
Due to several factors, health care practitioner fails to verify patient eligibility and copay amount. Most service providers do not check the patient's eligibility. In addition, patients make multiple visits to verify eligibility (Casto & Forrestal, 2013). In certain instances, patients are forced to wait for weeks to find out what they owe the health care facility. Workflow is a major hindrance to real-time verification (Casto & Forrestal, 2013).
Even ...