Problem
Scenario
After recent breakdowns in the revenue cycle at Happyville Health System resulting in lost net revenue, the health system's board of directors reached out to you, the Revenue Cycle Director. The board understands the basic operations of a revenue cycle. Still, they would like to understand more about the daily challenges Happyville Health System faces with healthcare reimbursement complexity. You suggest a presentation to the board at the next month's board meeting. You are added to the board meeting's agenda for a 30-minute presentation session.
Task
A presentation (with slides and speaker's notes) that:
A. Describes appropriate assignment of diagnostic and procedural codes and groupings in compliance with official guidelines, including examples that are easy to follow.
B. Illustrates the revenue cycle, including interactions between components, functions, and processes.
C. Differentiates between reimbursement models, including the variations and examples of each.
D. Examines the effectiveness of a coding compliance plan in appropriate reimbursement, including examples of successful compliance with specific external regulators.
E. Recommends improvements to the clinical documentation integrity (CDI) process, including specific examples of CDI processes that legally increase reimbursement.
F. Examines compliance with internal and external reimbursement guidelines and regulatory requirements, including examples demonstrating success with compliance.