Carlos Albizu University Healthcare Payment Systems Reimbursement Cycle Discussion

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reimbursement cycle Reply 1 to Martina:

For this week’s discussion, we evaluate the overall revenue cycle, which involves the reimbursement cycle and different payment system interfaces. In healthcare, payments are provided for different services provided in a hospital or facility. Most of these payments are based on a fee-for-service payment system, meaning that a payment is given for services. Similarly, there are also rules and regulations that revolve around the reimbursement cycle to provide quality care to patients. Within the reimbursement cycle, it includes “…provision of services, documentation of services, billing for services, filing a claim, and then eventually payment for the claim filed” (Abbey, 2010, p.66). The reimbursement cycle plays a big role in the revenue cycle as it is only concerned with providing care and services, as long as there is a third party involved. Otherwise, it would not fall under the reimbursement cycle.

The primary difference between a reimbursement cycle for a healthcare facility in contrast to a coding process in a nursing home is how and what they bill out. For a healthcare facility, the reimbursement cycle clearly states what needs to be billed, as in what services, supplies, and other items were provided for a third party to reimburse. On the other hand, the coding process in long term facilities, such as a nursing home, involve the ICD-10 codes assessing diagnoses, conditions, and/or diseases. The coding process allows healthcare providers to communicate information properly and assign diagnoses to billing. The codes used in a nursing facility, “…support medical billing by explaining why a patient sought medical services and the severity of their condition or injury” (RevCycleIntelligence, 2018).

References

Abbey, D. (2010). Healthcare payment systems: An introduction. Boca Raton, FL: Productivity Press.

RevCycleIntelligence. (2018, June 15). Exploring the Fundamentals of Medical Billing and Coding. Retrieved from https://revcycleintelligence.com/features/exploring-the-fundamentals-of-medical-billing-and-coding

reimbursement cycle Reply to Yanira:

Hello everyone,

For this week’s discussion, we are discussing the difference between the reimbursement cycle in most healthcare facilities and the coding process in long-term care facilities such as nursing homes or home health? The revenue cycle reimbursement is based on the day of service. The cycle is created the day the patient is receiving the services, and the billing will go based on that certain date of service. As soon as the patient walks in, a chart is created for the patient, being that everything gets billed to that specific patient with the codes that are required to be used for the service the patient received. If an error is done, the whole process of the billing process gets thrown off. In long-term facilities and home health or nursing homes, the process of payment is quite different. As per Abbey, D (2010) “The hospital may also contract with Skilled Nursing Facilities (SNFs) to provide PT/OT services to the SNF’s residents. For the Medicare program, these PT/OT services provided to the SNF residents are paid through the SNF payment system.” Home health and nursing home care based on long-term staying for the patient. The nursing home is able to charge patients for the daily, for the drug administration, food, and assistance that is required by staff members that are required to fully assist the patient. Oppose to home health, where there is a designated person to go over the patient’s home and just bill for those few hours of work.

Reference:

Abbey, D. (2010). Healthcare payment systems: An introduction. Boca Raton, FL: Productivity Press.