Overview
In this module, you learned about the significance of staffing in healthcare strategic planning initiatives and the revenue cycle. You also looked at the role of leadership to improve team performance and the areas in the back-end revenue cycle.
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To recap, the components in the back-end revenue cycle include (but are not limited to) the following areas:
- Claims Production
- Claims Submission
- Determining Expected Reimbursement
- Adjudication
- Benefits Statements
- Claims Reconciliation
- Denial Management
In this assignment, you will create an analysis report on the staffing system of a healthcare organization based on the identified areas of the back-end process of the revenue cycle.
This assignment will help you describe best practices for revenue-cycle staffing models and align staffing models with strategic planning initiatives. It will also enable you to demonstrate how key leadership competencies improve revenue-cycle team performance. From a healthcare management perspective, this activity will help you understand how to set up and manage a robust staffing process. This activity will help you prepare for sections 3 (Staffing Impact) and 5B (Workflow Assessment Findings) in the course project.
Directions
Create an analysis report on the staffing requirements in the backend process of a healthcare organization.
If you need writing support, access the Online Writing Center through the Academic Support module of your course.
Specifically, you must address the following rubric criteria:
- Staffing Competencies: Describe the staffing competencies needed for hiring team members in the back-end revenue cycle. Consider the following questions to guide your response:
- What competencies are needed for the back-end processes of the revenue cycle?
- What makes this competency specific to the healthcare domain?
- Revenue Integrity: Explain the importance of the back-end processes of the revenue cycle for preserving revenue integrity. Consider the following questions to guide your response:
- How do organizations incorporate operational efficiency in the back-end processes?
- How is compliance to regulatory requirements built into the back-end processes?
- Role of Leadership: Explain the role of leadership in ensuring staffing competencies. Consider the following questions to guide your response:
- What skillsets or knowledge should a leader look for when recruiting somebody for the back-end process?
- How would the leader keep the team updated in skillsets and knowledge?
- Lapses and Prevention: Identify processes to prevent lapses and/or gaps in the staffing model. Consider the following questions to guide your response:
- What kind of lapses and/or gaps are possible across the entire process?
- What are the possible reasons behind these lapses and/or gaps?
- Impact of Failure: Discuss the impact of any failure in the claims production and claims submission areas of the revenue cycle. Consider the following questions to guide your response:
- What are some of the possible events of failure that could happen in the first two areas?
- Who would be impacted by such events?
- Financial Impact of Declined Claims: Discuss the financial impact of initially declined claims and delayed payments to healthcare organizations. Consider the following questions to guide your response:
- Do healthcare organizations face the same financial impact for governmental and private insurance claims?
- What steps can be taken by the back-end processes staff and by leadership to ensure these delays do not happen?
All the claims in your deliverable should be evidence based. Your citations should be from your independent search for evidence (not from the textbook, or module resources) of credible sources and be current within the last five years. You are required to cite between 3-5 resources, with a minimum of three sources, at least one which is not also one of your Project One resources. Refer to the Library Guide located in the Start Here section of the course for additional support.
What to Submit
Submit your analysis report as a 5- to 6-page Microsoft Word document with double spacing, 12-point Times New Roman font, and one-inch margins. Sources should be cited according to APA style (add a brief introduction and a conclusion).
Module Five Project Preparation Rubric
| Criteria | Exemplary (100%) | Proficient (90%) | Needs Improvement (70%) | Not Evident (0%) | Value |
|---|---|---|---|---|---|
| Staffing Competencies | Exceeds proficiency in an exceptionally clear and insightful manner, using industry-specific language | Describes the staffing competencies needed for hiring team members in the back-end revenue cycle | Shows progress toward proficiency, but with errors or omissions | Does not attempt criterion | 10 |
| Revenue Integrity | Exceeds proficiency in an exceptionally clear and insightful manner, using industry-specific language | Explains the importance of the back-end processes of the revenue cycle for preserving revenue integrity | Shows progress toward proficiency, but with errors or omissions | Does not attempt criterion | 10 |
| Role of Leadership | Exceeds proficiency in an exceptionally clear and insightful manner, using industry-specific language | Explains the role of leadership in ensuring staffing competencies | Shows progress toward proficiency, but with errors or omissions | Does not attempt criterion | 10 |
| Lapses and Prevention | Exceeds proficiency in an exceptionally clear and insightful manner, using industry-specific language | Identifies processes to prevent lapses and/or gaps in the staffing model | Shows progress toward proficiency, but with errors or omissions | Does not attempt criterion | 15 |
| Impact of Failure | Exceeds proficiency in an exceptionally clear and insightful manner, using industry-specific language | Discusses the impact of any failure in the claims production and claims submission areas of the revenue cycle | Shows progress toward proficiency, but with errors or omissions | Does not attempt criterion | 15 |
| Financial Impact of Declined Claims | Exceeds proficiency in an exceptionally clear and insightful manner, using industry-specific language | Discusses the financial impact of initially declined claims and delayed payments to healthcare organizations | Shows progress toward proficiency, but with errors or omissions | Does not attempt criterion | 15 |
| Articulation of Response | Exceeds proficiency in an exceptionally clear and insightful manner | Clearly conveys meaning with correct grammar, sentence structure, and spelling, demonstrating an understanding of audience and purpose | Shows progress toward proficiency, but with errors in grammar, sentence structure, and spelling, negatively impacting readability | Submission has critical errors in grammar, sentence structure, and spelling, preventing understanding of ideas | 10 |
| Scholarly and Professional Sources | Incorporates more than two scholarly, current (within the last five years) sources, or use of sources is exceptionally insightful | Incorporates two scholarly, current (within the last five years) sources that support claims | Incorporates fewer than two scholarly, current (within the last five years) sources, or not all sources support claims | Does not incorporate sources | 10 |
| APA Style | Formats in-text citations and reference list according to APA style with no errors | Formats in-text citations and reference list according to APA style with fewer than five errors | Formats in-text citations and reference list according to APA style with five or more errors | Does not format in-text citations and reference list according to APA style | 5 |
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