Case Management

Mentor moment: Revenue cycle management

Case Management Weekly, October 24, 2012

Knowing how Medicare pays, variations in payment, and why Medicare pays provides a knowledge base for clinicians to ensure that patients receive care that is appropriate and defensible, and that hospitals are paid for providing that care. 

A lack of awareness, knowledge, or understanding of the following issues can potentially interrupt the flow of revenue: 

  • Documenting the discharge disposition code has a direct effect on accurate claims submission, as in the transfer MS-DRG
  • Finding a discrepancy in the insurance information that the patient provided on admission and providing the new and corrected information to the hospital business office will prevent a claim from being submitted to the wrong payer and causing a delay in the revenue cycle for the patient
  • Knowing that a patient is enrolled with a managed Medicare plan early in the admission will allow you to start determining which post-acute care services are covered, thus avoiding a delay in discharge 

Editor’s note: This article is adapted from Discharge Planning Guide: Tools for Compliance, Third Edition published by HCPro, Inc.

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