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Posted: December 11th, 2022
Principles of Healthcare Reimbursement and Revenue Cycle Management Student Workbook
Chapter 13
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Advanced Exercises
1. Denials Management Dashboard (Level 6—Creating)
Denial management is a key function of revenue integrity. To begin to understand why denials are occurring, denial management teams track denials and then utilize dashboards or trending reports to assist with root cause analysis. In this assignment groups create a denials management dashboard.
Create a system (spreadsheet or other tool) to track denials. Data elements that should be included in the system are:
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a. Encounter identifier
b. Payer
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c. Denial type
d. Date of denial
e. Total charges
f. Amount denied
g. Denial reason (create categories,e.g., coding error, clinical validation)
h. If appeal was initiated
i. Amount recovered
j. Additional elements students wish to include
Once you have created your tracking tool, populate it with 20 denied claims (all for the month of January 202X. You will populate your tool with fictious data. Try to create real-world scenarios for the 20 cases. Before you prepare your scenarios, review the information that is required for the dashboard portion of this assignment. For example, “top denial reasons by payer” is a metric; therefore, you should include three to four different payers within your 20 scenarios so you can populate this metric. Additionally, review information in the textbook to help you determine denial types and denial reasons.
Using the information you prepared and enteredin tracking tool, create a dashboard for January 202X. Again, you will create fictious data to populate your dashboard and report (i.e., patient service revenue). The metrics to include are:
a. Denial rate
b. Denial write-offs as a percentage of net patient service revenue
c. Top denial reasons by payer
d. Appeal success rate
2. Summarizing Medicare Compliance Documents (Level 6—Creating)
As a leader and manager, the health information administrator is responsible for communicating compliance requirements and regulations. This responsibility requires the manager to interpret compliance guidance documents, relate requirements to hospital-specific operations, create a plan of action, and execute the plan.
Go to the Medicare National Coverage Determinations Manual (Publication #100-03) located at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS014961. There are four parts to the manual and numerous sections. Review the table of contents and pick anNDC to use for this assignment. It would be wise to choose a topic that is of interest to you or that you know some information about. For example, if you have a family member with diabetes, you may be interested in #100.14, Surgery for Diabetes.
You are a data analyst at Memorial Hospital.You have been charged with preparing an educational session about the NCD because your facility has been receiving denials for this service.
Your educational session will be a self-guided slide deck presentation. Your slides should be formatted so that the viewer can obtain all information from the slides with or without a voice-over (i.e., the viewer is reading the slides). Your session should contain all pertinent information about the coverage or noncoverage for the service you have chosen.
Note: This is a Reimbursement assignment.
Copyright ©2021 by the American Health Information Management Association. All rights reserved.
Guidelines:
1. Individual assignment.
2. Submit an original work addressing the topic and questions provided and other relevant factors you may think of beyond the questions provided here.
3. No title page is required. Provide your name(s), the course and section number, and date in the header of the first page and subsequent pages.
4. If you use material from outside sources (i.e. the Internet), be sure to cite the source in the body of the paper where you use the information and provide an APA-style reference at the end of the paper.
5. The expected word count is 400-500 words, excluding the information in the header and any references.
6. A plagiarism checker is used, so be sure to cite and reference any outside source material.
7. You are writing with a professional audience in mind, so be sure to use a professional tone. Do not use a familiar tone as you might use when discussing this with a friend.
Assignment Scenario:
Your team has been hired as consultants to work with a large city to implement a program to place hundreds of high-tech digital cameras in strategic locations to aid in reducing crime and speeding help to victims. The cameras are state-of-the-art with infrared capability for night vison, high resolution, and rapid zoom in and out capability. Your city will be the first in the United States to deploy them. The manufacturer is a relative newcomer to the digital camera industry. The program has not yet been fully funded, nor has it been announced to the residents of the city. The city management and top-level officers within the police department are fully behind the program; however, lower level officers and cops on the street have mixed support. Your team has been asked to perform a risk assessment for this project. You are to identify various risks that could occur; assign them a high, medium, or low level or risk, and assess the potential impact (high, medium, or low) on the project if that risk should occur.
Submitting your Assignment
1. Click the Submit Assignment button.
2. Click the Choose File button and upload your file.
3. Click the Submit Assignment button to submit.
Rubric
Writing Rubric Template
Writing Rubric Template
Criteria
Ratings
Pts
This criterion is linked to a Learning OutcomeFocus
10 to >9.0 pts
Exceeds Expectations
All required components of the assignment are complete or go beyond requirements. The focus on the assignment directly aligns with the prompt and is appropriately narrow for the scope of the assignment.
9 to >7.0 pts
Fully
Instructions
· Use your paper topic. Then, reply to 2 classmates.
· Discuss your answers in a well-developed reply. See the rubric for clarification of expectations.
· You will see your classmates' responses only after you have submitted your initial reply.
· Click "Reply" below to begin.
Discussion Topic
You have nearly reached the end of your journey in this course.
In this discussion, you will submit your final presentation and review presentations from at least two other classmates. Recall from the syllabus that this activity accounts for 10% of your total course grade. Your presentation counts for 70% of the grade for this assignment. Your replies count for the remaining 30%, so make sure your replies are substantial and add to the overall quality of the discussion.
Note: 150 words
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