Sample Healthcare Paper on Health Care Finance and the Mechanics of Insurance and Reimbursement

Revenue is generated by the provision of care to the patients. Patient care can range from complicated surgery to a minor laboratory test. All of the services provided are avenues for revenue. There should be proper documentation to enhance payments. The whole organization plays a role to ensure that there is proper documentation in the process of caregiving to generate revenue. In a given healthcare facility, the revenue cycle follows the guidelines that are geared towards drawing revenue. Often, the cycle constitutes of patients, healthcare providers, and insurers who have a vital role in the relationship between revenue cycle and reimbursement. Health care providers authorize treatment and ensure that payment is made. Patients must ensure that they have proper documentation for the insurer to pay a healthcare provider.  

The clinical facilities must ensure that there is proper care and determine the documentation needed to enable them to receive payment (Harrington 105). The clinical facilities should also ensure that all documents are error-free to avoid disruptions in payment. In case there is no payment received, the healthcare organization will not receive payment for the treatment offered to a patient. In such a situation, the hospital suffers a loss. Revenue cycle and reimbursement are interrelated in a way that they operate dependently of one another. Reimbursement may be denied if there is missing information. Most hospitals are keen on ensuring that patients are registered and authorized for treatment (Rauscher and Wheeler 45). However, people are not perfect, and mistakes are often made, which leads to complacency in the provision of healthcare services.

Peer Response

K B,

You have a great explanation of the significance of reimbursement. The crucial thing in the revenue cycle is the cash flow, which should be consistent. The middle process should be given much emphasis because it mostly involves billing. Efforts should be made to reduce errors in beginning stages of treatment, which may end up affecting billing and increasing the risk of denial of reimbursement.

Works Cited

Harrington, Michael K. Health Care Finance and the Mechanics of Insurance and Reimbursement. , 2020. Print.

Rauscher, S, and J.R.C Wheeler. “Effective Hospital Revenue Cycle Management: Is There a Trade-Off between the Amount of Patient Revenue and the Speed of Revenue Collection?” Journal of Healthcare Management. 53.6 (2008): 392-406. Print.