From the Novitas Jurisdiction H or JH home page select Claim

From the Novitas Jurisdiction H (or JH) home page, select “Claims” from the left menu, then select “Part A Top Claims Submission Errors” for Oklahoma. Review the errors and answer the following questions:

Discuss two of the top claims submission errors identified.

Which of the revenue cycle functional areas (i.e., scheduling, coding, billing, etc.) could most impact a process improvement effort to correct the claims submission errors? Explain why.

Refer to the “Revenue Cycle 101” presentation from Module 1 for a list of the revenue cycle functional areas.

Solution

Revenue cycle is a combination of processes whose end result is cash (net revenue)

Revenue Cycle Processes

Up stream Processes

Scheduling =Preregistration=_Verification^{= Authorization}= Financial counseling = Registretion=Bed

Control=_Verification^{Authorization}

^{Midstream Processes}

^{Financial Counseling=In house Management=Discharge}

^{Down Stream Processes}

^{Customer Service}

^I

^{Coding=Billing=Followup=Denial/underpayment=Self pay collection=Collection Agency/bed debt}

   I

Cash payment