What key activity occurs during Step 8 of the revenue cycle?

What key activity occurs during Step 8 of the revenue cycle?

• A. Checking out patients
• B. Monitoring payer adjudication
• C. Reviewing coding compliance
• D. Following up payments

Answer: (B)

During Step 8 of the revenue cycle, monitoring payer adjudication is a critical activity. This step involves tracking the claim process after it has been submitted to the insurance payer. It's essential to ensure that the claims are being processed in a timely manner and that they are adjudicated correctly according to the payer's policies and procedures. This oversight helps to identify any potential issues that may arise during the claims processing, such as denials, underpayments, or delays. By actively monitoring adjudication, healthcare organizations can address problems early on, which is crucial for maintaining cash flow and revenue integrity. Understanding the status and outcome of claims submitted to payers helps inform further actions such as appeals, corrections, or adjustments that may be necessary to optimize revenue collection. The activities related to checking out patients, reviewing coding compliance, and following up payments, while important, do not specifically pertain to the ongoing process of claims adjudication that occurs once the claim has been submitted to the payer.

During Step 8 of the revenue cycle, monitoring payer adjudication is a critical activity. This step involves tracking the claim process after it has been submitted to the insurance payer. It's essential to ensure that the claims are being processed in a timely manner and that they are adjudicated correctly according to the payer's policies and procedures.

This oversight helps to identify any potential issues that may arise during the claims processing, such as denials, underpayments, or delays. By actively monitoring adjudication, healthcare organizations can address problems early on, which is crucial for maintaining cash flow and revenue integrity. Understanding the status and outcome of claims submitted to payers helps inform further actions such as appeals, corrections, or adjustments that may be necessary to optimize revenue collection.

The activities related to checking out patients, reviewing coding compliance, and following up payments, while important, do not specifically pertain to the ongoing process of claims adjudication that occurs once the claim has been submitted to the payer.