In health care organizations, focus of the management must be given to the financial aspects as income must be forecasted according to existing contracts with stakeholders. Healthcareprocessionals are responsible for supporting viable emergency care and they must manage finite resources to achieve legal imperatives (Gupta, 2020). A healthcare organization can earn money in different ways. As a role of an office manager, it is my duty to help the physicians to try to manage their own billing processes efficient. I observed that this proactive is not followed by the clinic consistently and the billing policies need an upgrade, therefore, I need to develop financial strategies that help the organization to address dynamic environmental forces and revenue cycle and recommend a new pricing strategy.
According to Kamble (2018), healthcare organizations can conduct several steps for revenue cycles such as preregistration, registration, charge capture, claim submission to name a few. The first step is preregistration that allows medical centers to gather demographic data and insurance information as well as eligibility datathrough a clearinghouse. This data then transfers the two-insurance carrier of the patient and flows through the provider’s practice management system (). This helps the provider to know more about the coverage of the patients. The second process in revenue cycle is registration that ensures 100% accuracy of patients’ data from start to finish and also helps providers to collect and save vital information such as phone number, date of birth, guarantors, and insurance information of their patties. The Charge Capture is the next step that allows for the information to automaticallyflow into the practice management billing side based on what the provider puts in their documentation.
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The next step is the Claim Submission that allows for sending information to the insurance carrier when the charges are stored in the system. The teams can observe the charges and the CPT code and ask questions related to the matching of the procedure with the diagnosis. The next step is claim submission that includes sending information to the insurance carrier after the charges have been entered (Mohamed, 2021). In the last two steps, the first thing to do is the remittance process that includes getting the remittances back and explaining the benefits to the practice. The calculation of allowable is done here that allows providers to know their contract with the insuranceproviders. Insurance follow-up is the last stage that allows medical experts to view what is paid and not paid? For instance, they can observe the Accounts Receivable report that facilitates the insurance follow-up after knowing what is sitting in the insurance. That allows for Patients Collections that involves getting money from the pateints while they are in the clinic. This requires creating a standard policy for collecting copayments. Therefore, each step of revenue collection is important to help the providers and the pateints get along with each other well.
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Pricing strategies provide vital signal to healthcare organization leaders to determine their right resources for an accurate delivery of services. Health care industry is not a classic marketplace for goods and services. Customers are often referred to as “health insurers” or purchasers who possess lesser information that makes them less sensitive to prices (Sousa et al., 2019). Provider payment systems are based on specific payment methods and supporting mechanisms. The price shows that the cost of delivering services is covered and it also offers vital incentives to medical centers and hospitals. For instance, our hospital serves a number of low-income patients to ensure coverage and quality. The prices are often adjusted to achieve the set objectives of this healthcare organization. In the US, the prices are determined though the method of individual negotiations. This means that the prices are agreed upon through negotiations between patients who pay and the healthcare insurers. The price negotiations are also popular in the United States due to recent pressures to increasing consumer sensitivity to prices (Senthilkumar et al., 2018). This means that the providers and the customers will have higher bargaining powers. Therefore, in such type of a system, under such a system, the healthcare organization agrees to acc
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