《医院营收周期管理》PPT课件

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1、HospitalRevenueCycleManagement医院营收周期管理HealthSystemsManagement医疗系统管理SylviaPanUnitedFamilyHospitalandClinicsVicePresidentTheRevenueCycleisthehowamedicalfacilityisreimbursedforitsservices营收周期是指一个医疗机构从提供服务开始,到获得收入补偿的全过程-usuallythefirstandlastencounterapatienthaswiththeins

2、titution.通常患者在医院最先和最后接触的都是从事这项工作的人员(如:前台,收银人员)RevenueCycleOverviewAdmissions-Registration患者–登记Notethatcashieringisnotunderadmissions.Registration注册登记Registrationisthecollectionoftheappropriatedemographicinformationtorequiredtosubmitacleanclaimtoainsuranceprovider.Twoty

3、pesofregistration:注册登记是为了获取适当的信息,向保险公司提交清晰的资料.分为两种:1.Pre-registration:Wherethefacilityhadadvancenoticefortheelectiveprocedure.预先注册:医院可以预先通知为某个诊疗进行注册2.SiteRegistration:Registrationthatoccursatthetimeofservice.定点注册:在提供服务时进行注册Demographics登记注册的内容Name,address,phonenumber,em

4、ail姓名,住址,电话号码,电子邮件地址Insurancecarrier,identificationnumber是否购买保险,保险号Emergencycontact急沴联系人Referringphysician推荐医生Employer雇主Guarantor保证人EligibilityDetermination患者支付能力的确认InsuranceVerification–保险审核－Istheirinsurancecoveragevalid,是否在有效的保险期内isitcredible是否可信doesitcovertheseserv

5、ices是否属保险公司有效赔付范围内Pre–Certification–Doestheprocedurehavetobepre-certifiedbytheinsurancecompany.预先通知－确认该诊疗是否需要预先通知保险公司Dotheyhaveaco-insuranceordeductible确认患者是否有自付部分或绝对免赔额RegistrationCollections注册信息Doespatienthaveco-pays,deductibleorco-insurance?确认患者是否有自付部分或绝对免赔额Mustknow

6、payercontracts务必了解付款者的合同Reviewinsurancecards核查保险卡Buildintopre-certificationprocess设定预先通知系统Doespatienthavebalancesdueonotherservice?确认患者是否有其它到期未付的诊疗费Delayordenyserviceiftheycan’tpay?如患者不能支付费用，是否需要延期或拒绝提供服务ChargeCapture收费信息的获取Chargingaccuratelyfortheservicesandsuppliesus

7、edtotreatthepatient.确保对所提供的服务和治疗用品准确收费SuperBills帐单BarCoding条码ManualentrytoI/Ssystem人工录入I/S系统LateCharges延期的收费Chargesenteredafterbillhasbeencreated开出帐单后，录入费用Requirerebilling与保险公司再次核对赔付额SomeinsurerswillnotacceptLateChargeReports–Tracking建立延迟支付保费报告,并对支付进行跟踪Systembasedelect

8、ronicchargingeliminatesmostlatecharges系统应尽量杜绝延迟支付的费用LateCharges延期的收费Daysofchargeentrylagdateofservice-dateofchargeent