Reference no: EM132345324

You have recently been hired as the VP of Revenue Cycle Management for Happy Valley Regional Health System in Winston Salem, NC. The system is consists of an academic medical center, two community hospitals and 24 outpatient primary and specialty clinics. The hospitals has annually: 50,000 admissions, 75,000 ER visits, 900,000 outpatient encounters, and 1.3 million clinic visits. You have been tasked by the director to improve the revenue cycle process. Some issues that you have identified with the current process:

1. Failure to get insurance verification
2. Failure to get insurance information
3. Ordering services that are not preauthorized
4. Performing medically unnecessary services
5. Submitting charges after the allowed documentation period
6. Improper matching entries with charge-master file
7. Documentation and coding errors
8. Lag times in coding
9. Failure to follow specific billing rules
10. Mishandling of insurer payment denials
11. Posting errors that mis-state the remaining outstanding patient balances

Also include some discussion on how these improvements can save the organization money and increase its revenue. Provide some discussion on how you will gain employee buy-in with regard to the changes.