Hello there! Want a discount? Grab 5% OFFon your first order!
tutorfaith.com logo
Hello there! Want a discount? Grab 5% OFF on your first order!

Our Services

Get 15% Discount on your First Order

A claims payer (also known as an insurance company) may deny claims based on individual line-item claim data. This denial generally happens for several

A claims payer (also known as an insurance company) may deny claims based on individual line-item claim data. This denial generally happens for several reasons: intake errors on the front end during patient registration, mismatch with diagnosis and procedure coding documented by the health system, or technology issues. If the claim is denied, health systems are required to resubmit the claim, either by correcting the error(s) on the claim or submitting an appeal if they disagree with the denial. Insurance companies may require a resubmission of all original documents. This process is part of the revenue-cycle workflow of a healthcare organization.

This discussion will help you assess the internal and external revenue-cycle workflows and their impact on strategic planning and financial management. It will also enable you to evaluate how the revenue cycle is impacted by insurance plan requirements and regulations and identify front-end, middle, and back-end revenue-cycle processes within operational workflows.

This discussion will help you to prepare for sections 3 (Healthcare Reimbursement), 4 (Revenue-Cycle Process), and 5C (Technology and System Impacts) of the course project.

Imagine you work with a healthcare organization, and you are helping the internal audit team analyze quarterly financial performance. The audit team found several claim denials in the outpatient surgery center and has asked you for a better understanding of the situation.

In your initial post, include the following details:

  • Explain how technology and human error may contribute to a denial by the insurance company.
  • Identify at least one internal process breakdown each from the front-end, middle, and back-end workflows that could lead to a claim denial.

Share This Post

Email
WhatsApp
Facebook
Twitter
LinkedIn
Pinterest
Reddit

Order a Similar Paper and get 15% Discount on your First Order

Related Questions

1.  On a systemic level, consider whether the practice of issuing earnings forecasts is good, bad, or indifferent.  Is the practice of issuing earnings

1.  On a systemic level, consider whether the practice of issuing earnings forecasts is good, bad, or indifferent.  Is the practice of issuing earnings forecasts a socially beneficial one? Should the practice be encouraged, required, discouraged, or prohibited? Does the practice encourage deception or manipulation? 2. consider whether the corporate

 Assume you are the packaging engineer for a large consumer products company. In this company, the Packaging Design Briefs are initiated by the marketing

 Assume you are the packaging engineer for a large consumer products company. In this company, the Packaging Design Briefs are initiated by the marketing group and forwarded to the Package Engineering group. You currently are working on three packaging design briefs. Copies of these design briefs are attached. Note that the marketing department has

BUSI48Z15 Global Supply Chain Leadership

BUSI48Z15 Global Supply Chain Leadership Postgraduate Programmes 2023/24 SUMMATIVE ASSIGNMENT BUSI48Z15 Global Supply Chain Leadership Select any real (large, micro or small) multinational business. Study its background and identify its challenges in operations management. Give suggestions to the company and evaluate the effectiveness of your suggestions using the methodologies learned