You Decide Assignment: Accounts Receivable Issues

Matthew Smith
Week 2 You Decide Assignment
Accounts Receivable Crisis
09/05/11
Instructor: Eric Oestman
Class: HS543

I. INTRODUCTION: After conducting a meeting with the medical staff, various clinical departments, Health Information Management, and Business office personnel regarding Accounts Receivable issues within our facility, it was determined that many different areas of concern needed to be addressed. This includes problems with patient admission and registration procedures, claims processing, an inadequate amount of information being written in charts, rejected claims, and patient follow up. Many suggestions from all departments were made during the meeting in an attempt to decrease the number of days that necessary
funds are being tied up within Accounts Receivable. In addition to the recommended solutions made by staff members, further suggestions will also be included in this presentation which include ways to ensure that all claims are processed efficiently and in a timely manner. II. ACCOUNTS RECEIVABLE MODIFICATION PLAN i. Pre Deployment Requirements
Prior to implementing a plan of action to address our current Accounts Receivable crisis, specific criteria must be collected from all departments within our facility. The following criteria will consist of a complete record of all credit amounts which include precise approval and maturity periods, simple debtor background information such as employment position, how they receive money, amount of family members in household, and current place in which they reside. In addition, various documents that shows the exact date in which our establishment physically acquired funds from the patient will also need to be requested.

III.
SOLUTIONS FOR EACH DEPARTMENT
In order to resolve this problem, a combined effort from all departments within this organization must be implemented. This includes the Administrative department, the Finance department, the Health Information Management department, as well as the patient. Each department will provide a specific set of functions from various resources to the overall execution of the newly designed plan. i. Administrative department As you may well know, Admission and Registration is probably the most important department and is the first line of defense against this pressing issue. Properly documenting critical patient data, such as insurance information can literally save a considerable amount of money as well as ensure a faster payment. In an effort to reduce employee errors involving insurance changes during this phase of the process, an increased amount of training classes will be conducted that would explain in full detail about what the procedures are for checking in a patient and a special session that focuses on proper insurance data collecting. In addition to this, a staff member suggested that a full time individual be utilized on a 24 hour basis. The full time clerk will be responsible for the inspection of all other employees’ paperwork to catch any discrepancies that might occur. According to Brown, J. (July 2000), “Manual Claim Reviews including utilization and medical reviews are conducted by trained specialists. Staff
specialists review specific claims with established program and medical policy, with previously paid claims, and with other information to decide if Medicaid should pay for the services.” Once this task is complete, the data will be passed on to the medical record department for further processing.

ii. Finance department
To reduce the number of days that funds remain within Accounts Receivable, an analysis must first be conducted to determine which dollar amounts are either paid or delinquent.
This objective typically requires the utilization of an Aging of Accounts Receivable Schedule, which can be retrieved from resources such as financial department records. According to Emerson, P. (n.d.), “The accounts receivable schedule is a listing of the customers making up the total accounts receivable balance. Most businesses prepare an accounts receivable schedule at the end of the month.” Accessing this critical data can be quite useful and will give the company a much clearer picture as to why this issue is
occurring. iii. Health Information Management department The Health Information Management department and medical coding personnel’s contribution to controlling the Accounts Receivable dilemma consists of decreasing the influx of rejected claims from various insurance providers as well as ensuring that all submitted paperwork from the Administrative department is finalized and thoroughly checked for errors prior to submission. To accomplish these tasks, pertinent information such as reports, medical charts, and patient data should be gathered and referenced. iv. The Patient
The final contribution to prevent any future Accounts Receivable problems from happening, incoming patients needs to properly inform the admitting staff member of any recent changes that were made to insurance providers and their current health condition. Although some of the burden of maintaining accurate background information lies on the medical staff, the remainder of the responsibilities falls upon the patient. IV. CONCLUSION These specific solutions will not only increase this organization’s bottom line, but it will also make the entire process of both billing and the receipt of funds a whole lot smoother. Proper communication between all departments and the patient must be a continuous process if a desirable outcome is to be achieved. Failure to do so will negatively impact the entire hospital.

REFERENCES:
Brown, J. (July 2000). Medicaid Claims Processing Safeguards. Retrieved September 05, 2011 from http://oig.hhs.gov/oei/reports/oei-05-99-00071.pdf
Emerson, P. (n.d.). Scheduling Accounts Receivable. Retrieved September 07, 2011 from http://www.bizbodz.com/finance/General-Finance/Scheduling-Accounts-Receivable.asp