Monitoring the Revenue Cycle
Alfred State Medical Center's charges, payments, and adjustments from third-party payers for the month of July are represented in the table below. As part of your responsibility as a member of the Revenue Cycle Performance Committee, you are required to monitor various component of the revenue cycle and report your findings to the committee. The committee uses your report to determine new and continued contracts with specific payer types.
In preparation for your report you must calculate and analyze the data.
1. Calculate the percentage of charges, payments, and adjustments for each third-party payer and enter the percentages in the percentages columns of the table.
|
Payer
|
Charges
|
Payments
|
Adjustment
|
Charges
|
Payments
|
Adjustments
|
|
BC/BS
|
$450,000
|
$360,000
|
$90,000
|
|
|
|
|
Commercial
|
$250,000
|
$200,000
|
$50,000
|
|
|
|
|
Medicaid
|
$350,000
|
$75,000
|
$275,000
|
|
|
|
|
Medicare
|
$750,000
|
$495,000
|
$255,000
|
|
|
|
|
TRICARE
|
$150,000
|
$50,000
|
$100,000
|
|
|
|
|
Totals
|
$1,950,000
|
$1,180,000
|
$770,000
|
100%
|
100%
|
100%
|
1. Based on the percentages calculated in the charges column, identify the payer the facility does the most business with and the payer it does the least business with.
2. Based on the percentages calculated in the payment column, identify the payers that reimburse the facility the most and the least.
3. Based on the percentages calculated in the adjustments column, identify the payers that proportionately reimburse the facility the most and the least.
4. Prepare a report of your findings and recommendations regarding specific payers to present at the next Revenue Cycle Performance Committee.