HI555 Unit 8 Seminar Reflection Example

Two Numbers for One Month: A Unit 8 Seminar Reflection on Why Health Information and Finance Disagreed About Unbilled Days

[Student Name]

Purdue University Global

HI555: Revenue Cycle Management

Unit 8 Seminar Reflection

[Instructor Name]

[Date]

Bellcourt Health, the writer, the classmates and every figure are composite; the sources cited are real.

Where I Started

The two numbers came from the same system for the same month. My department, health information, reported 3.1 days of discharged-not-final-billed accounts. Finance reported 6.4. Before the seminar I wrote in my notes: "Ours is the number that leaves out the inconvenient accounts, and finance knows it." I expected the session to confirm that health information had been shading its figure and to give me a way to say so diplomatically to my own director.

The Question That Turned It

The discussion went the way I expected for twenty minutes. A classmate from finance at another hospital defended the larger number as the only one that matched cash. Another classmate, from coding, defended the smaller one as the only one coders could control. Then a classmate who works in patient financial services asked a simple question: "When does each of your clocks start?" Nobody in the room had ever been asked that, and it turned out that neither side could answer for the other.

The disagreement was never about honesty; it was about two departments starting their clocks at different moments and never saying so aloud.

Taking the Gap Apart

Working through the answer that evening, I could account for the 3.3-day difference in three parts.

First, clock start. Health information starts counting when a chart is complete and available to code. Finance counts from discharge. At Bellcourt, charts take a median of about a day and a half to become available after discharge, because of transcription and late documentation. That accounts for roughly 1.4 days of the gap.

Second, excluded holds. Our department's report leaves out accounts on physician query hold, on the reasoning that coders cannot finish them until the physician answers. Finance includes them, because the account is unbilled whatever the reason. Query holds that month added about 1.1 days.

Third, the conversion from accounts to dollars. Health information counts accounts. Finance converts the unbilled dollar balance into days using average daily revenue, so large inpatient accounts weigh far more than small clinic visits. Because the accounts waiting longest tend to be complex inpatient stays, the dollar method adds about 0.8 days.

The arithmetic is approximate, since the parts interact, but 1.4 plus 1.1 plus 0.8 gives the full 3.3 days.

What the Standard Definition Settles

A classmate pointed us to HFMA's MAP Keys, which define days in total discharged not final billed as the unbilled dollar balance from discharge divided by average daily gross revenue. That definition settles which clock is standard for comparison across hospitals: it is finance's. It does not settle what a coding department should watch day to day, and it was never meant to. Finance textbooks treat unbilled receivables as part of working capital, measured in dollars because dollars are what the organization must finance while it waits (Gapenski & Reiter, 2016). A coding manager, by contrast, needs to know which charts are ready and not yet coded.

Where I Landed

I moved in two directions at once. The health information number was not dishonest. Each exclusion had a reason, and the report labeled itself as counting from chart availability, although nobody outside the department read the label. At the same time, it was the wrong number to bring to a conversation about cash. When our director presented 3.1 days to the finance committee, she was answering a question nobody had asked.

The seminar also changed how I think about disagreements between departments. I had assumed that when two reports differ, one must be inflated or deflated on purpose. Here, both were accurate answers to different questions. Health information management texts describe performance measures as useful only when their definitions are shared by everyone who acts on them (Oachs & Watters, 2020), and I now understand that sentence as practical advice rather than a truism.

My Proposal

I plan to propose one standard monthly figure for Bellcourt, using the MAP Keys definition so it can be compared with other hospitals, broken down underneath by hold reason: awaiting chart completion, awaiting coding, on physician query, on scrubber edit and on registration hold. Each department can then see its own share of one number instead of defending a number of its own. Healthcare finance writers make the point that working capital measures should drive action by the people who can change them (Nowicki, 2021), and a breakdown by hold reason does that.

What Remains Open

I am still unsure whether the coding department should keep reporting its own measure alongside the standard one. Coders need a target they control, and the standard figure includes delays they cannot touch. Two numbers caused this confusion in the first place, so I will ask the seminar group whether a single figure with a breakdown is enough.

References

Gapenski, L. C., & Reiter, K. L. (2016). Healthcare finance: An introduction to accounting and financial management (6th ed.). Health Administration Press.

Nowicki, M. (2021). Introduction to the financial management of healthcare organizations (8th ed.). Health Administration Press.

Oachs, P. K., & Watters, A. L. (Eds.). (2020). Health information management: Concepts, principles, and practice (6th ed.). AHIMA Press.