From the Novitas Jurisdiction H (or JH) home page, select “Claims” from the left

Question

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.

Explanation / Answer

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=VerificationAuthorization

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

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