You are a staff member in the finance department at Nouveau Health, whose sole responsibility is to advance the success of the organization through assisting in planning, forecasting, and finance management. The chief executive officer (CEO) of Krona has asked that you complete the following:
- Explain how revenue cycle influences the building of the new hospital
- Discuss why increased outpatient services will be required to improve revenue in a bundled care, accountable care, valued based environment
- Discuss 3 ethical concerns in the new billing environment
Respond requirement: 400-600 words.
Expert Solution Preview
Introduction:
Revenue cycle management is a crucial aspect of any healthcare organization, and it plays a vital role in the building of new hospitals. In this response, we will discuss how revenue cycle influences the development of new hospitals, why increased outpatient services are required to improve revenue in a bundled care, accountable care, valued based environment and lastly, the ethical concerns that arise in the new billing environment.
1. Explain how revenue cycle influences the building of the new hospital
The revenue cycle has a significant impact on the development of new hospitals. It involves the process of managing the financial activities of a healthcare organization, including the reimbursement of patient services. In a new hospital, revenue cycle influences the development in the following ways:
a) Planning and Design: The revenue cycle team plays a vital role in the planning and design of a new hospital. They estimate the expected revenue of the new facility, analyze patient data to forecast demand and plan resources accordingly.
b) Procurement: Revenue cycle team assists in the procurement of medical equipment, technology as well as aids in developing financial policies.
c) Cost-Effective Operations: It enables the hospital to operate in a cost-effective manner and ensures that financial resources are adequately utilized.
2. Discuss why increasing outpatient services will be required to improve revenue in a bundled care, accountable care, valued based environment
In today’s healthcare environment, providers are moving towards a bundled care, accountable care, and value-based care models. These models incentivize health care providers to deliver high-quality care while reducing costs. To achieve this, increasing outpatient services is crucial for the following reasons:
a) Improved Patient Outcomes: By providing preventive care, early diagnosis, prompt treatment, patients are more likely to manage any underlying medical conditions better. It keeps them out of the hospital, reducing their medical costs while improving patient outcomes.
b) Reduced Costs: Outpatient services are cost-effective compared to inpatient services, resulting in a reduced cost of care that fits well in the bundled Care environment.
c) Increased Utilization: Increased utilization of outpatient services can increase the utilization rate, thus resulting in increased revenue for the health care organization.
3. Discuss 3 ethical concerns in the new billing environment
The new billing environment comes with new ethical considerations, which include:
a) Upcoding: Upcoding or increasing the severity of a patient’s condition to maximize reimbursement is unethical, and it is regarded as fraud.
b) Balance Billing: Patients receiving surprise bills, after Insurance has paid their share, is unethical and leads to patients’ financial burden.
c) Medical Necessity: Physicians, billing employees may be tempted to create a sense of urgency, exaggerate diagnoses or overuse services to increase revenue. It is vital to ensure care delivery is medically necessary and needed.
Conclusion:
In conclusion, the revenue cycle plays a critical role in the development of new hospitals. The management of financial activities such as reimbursement, planning, and procurement is necessary for effective healthcare service delivery. Increased outpatient services promote preventive care, improved outcomes, and increased utilization, which aligns with bundled care, accountable care, and value-based care models. Ethical considerations such as upcoding, balance billing, and medical necessity are necessary to ensure the care delivery is patient-centered and medically necessary.