Kent Walters Health Care Revenue Cycle

Kent Walters PowerPoint and video outlined the health care revenue cycle and explained how complex it is, and explained the several processes which take place. Some of the topics he touched over were payment from insurance companies, risks from underwriting, Medicaid, Medicare, self-funding, etc. Kent explained how the services provided to patients are handled and after the period of treatment is done how the institutions collect the revenue, hoping to obtain a profit. Kent went into detail how important it is to have a strict upfront payment system and a reliable billing process for medical bills. There are many elements that go into making the system run efficiently to make it more profitable.

Walters also went into detail about electronic claim submissions and how clearinghouses charge a fee per claim. He went into the importance of electronic claim submissions and defined it as a paperless claim form generated by a computer that is transmitted electronically over telephone or computer to a health insurer or third party payer. Kent concluded by saying that the use of electronic claims can results in financial savings for physicians and payers.

One topic I want to reflect on that was interesting to me, is the provider process flow. This process explains how the medical billing process starts from insurance verification, then to correct entry of patient information, correct entry of coding, correct charge entries, claim submission and follow up. The process is basically a healthcare provider submitting and following up on claims, to eventually receive payments for services rendered.  

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