For one of the studies for this assignment, you conducted independent research into health care revenue cycles and billing processes. You will be incorporating this information into your assignment.
Imagine that you have just stepped into a new role as the office manager for a successful medical clinic. The clinic is a conglomeration of physicians offering specialized care. Each physician group tried to manage its own billing process. It quickly became clear that one billing office would be more efficient. You realize a lack of consistency has existed in the clinic and that you will need to update the billing policies and procedures immediately. You also recognize that people often resist change. One way to minimize this resistance is to provide credible evidence supporting the changes you plan to make.
You assignment is to prepare a proposal for the physicians about the billing policy and procedure changes you plan to make. To help ensure buy-in from the physicians, you will provide relevant evidence to support each change.
Instructions
Write a proposal for changes you would like to make to the billing policies and procedures for a physicians’ clinic. Include all of the following in your proposal:
Explain how the proposed changes will benefit the patients, physicians, and the clinic.
Develop a step-by-step process for the entire revenue cycle, from preverification of insurance to accounts receivable management.
Recommend a method for determining a pricing structure.
Be sure to consider the factors that influence pricing.
Explain the factors to be considered when negotiating insurance contracts.
Determine the major payer categories appropriate for this practice.
Explain how the clinic will handle private pay and charity care.
