In the transcripts provided, you are a CRP at a community Hospital where there has been a reduction in revenue reported over the last three months. You must determine where the source of this problem lies and what can be done about it.
January 2, 2018
Critical Case for Billing and Coding
In this scenario, the Student is a CFO at a community Hospital where there has been a reduction in revenue reported over the last three months. The Student must determine where the source of this problem lies and what can be done about it. As the scenario opens, the Student discusses with friend and mentor, Cheryl Noki, the former CFO of the Hospital, the revenue problem and how it is most pronounced in the outpatient arena. The Student sends a message to Controller, Michael Dean, who runs a volume report. They discuss and realize that the outpatient volume has been up over the last year, and this is not the problem. After another discussion with the Cheryl, the Student asks Michael to look at the revenue and usage summary for the current and past year. They discover a low level indicated in the charge master for the hospital, where it should be up. They pinpoint the problem is due to improper coding. The CEO of the hospital, Meredith Lynn, doubts the results, though, and the Student must resolve the doubt by learning and reporting back on the different types of Medicare billing and payments. In the end, the Student will review the key points learned in the scenario through a natural assessment that will be simulated through either a discussion with Cheryl, or through a multiple choice or drag-and-drop exercise.
1. Cheryl Noki
2. Michael Dean
3. Meredith Lynn
1. Hospital Lobby
3. Conference Room
4. Student’s Home
5. Coffee Shop
6. Finance Copy Room
Health Care Finance Navigate 2 Scenario: Critical Case for Billing and Coding
January 2, 2018
Scene 1: Meeting Your Mentor
As this scene begins, the Student talks with mentor, Cheryl, in the hospital lobby where they talk
about a problem in revenue.
Location Hospital Lobby
Scene setup Student is standing, facing Cheryl
On-screen characters Cheryl Noki
Off-screen characters None
On-screen Text: You run into former CFO, Cheryl Noki, in the lobby…
CHERYL: Hi there! How’s the new CFO? I see the place hasn’t fallen apart without me… yet…
STUDENT: Hi, Cheryl! I haven’t seen you for a while! Well, it hasn’t fallen apart yet, but everyone
misses you. What brings you here today?
CHERYL: I’m here to get coffee with an old friend. I work right down the street . . . I’m on the
faculty at the University, an adjunct, actually.