Included in full: an HCM 345 Module 3 Milestone One draft that maps the revenue cycle to the departments responsible for each stage, presents key indicators in a table, and explains how patient access, clinical documentation, coding, case management and billing each affect reimbursement. Searches like "hcm 345 module 3 assignment", "hcm345 module 3 final project milestone one" and "hcm 345 module 3 example" land here.
The HCM 345 Module 3 example, in full
Milestone One: Departmental Impact on Reimbursement at a Composite Regional Health System
[Student Name]
Southern New Hampshire University
HCM 345: Healthcare Reimbursement
Module Three Final Project Milestone One
[Instructor Name]
[Date]
The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.
Milestone One: Departmental Impact on Reimbursement at a Composite Regional Health System
The Organization
Lakemont Regional Health is a composite nonprofit health system with a 210-bed acute care hospital, 14 primary and specialty care clinics and an outpatient imaging and surgery center. In fiscal year 2025 it recorded net patient revenue of 412 million dollars. Its payer mix, measured by gross charges, was 44 percent Medicare, including Medicare Advantage, 18 percent Medicaid, 33 percent commercial insurance and 5 percent self-pay. The system is paid in several ways at once: fixed payments per admission under Medicare's inpatient prospective payment system, outpatient payments by service, negotiated contract rates with commercial insurers and a small share of value-based arrangements. Because nearly half its revenue comes from Medicare programs that pay fixed amounts, the system's margin depends less on what it charges than on whether it documents, codes and bills each encounter completely and correctly (Casto & White, 2021).
Revenue Cycle Performance
Table 1 shows the system's main revenue cycle indicators for fiscal year 2025 against its internal targets.
Table 1
Revenue Cycle Indicators, Lakemont Regional Health, Fiscal Year 2025
| Indicator | FY2025 result | Internal target | Department most responsible |
|---|---|---|---|
| Clean claim rate (share passing payer edits the first time) | 86% | 95% | Patient access, coding, billing |
| Initial denial rate (share of claims denied) | 11.8% | 6% | Patient access, case management |
| Discharged not final billed | 7.4 days | 4 days | Health information management |
| Days in accounts receivable | 52 days | 40 days | Patient financial services |
| Point-of-service collections (share of patient responsibility) | 22% | 35% | Patient access |
Note. Composite figures for illustration.
Patient Access
Patient access, which covers scheduling, registration, insurance verification, prior authorization and financial counseling, is the first department to touch every account, and its errors travel through the whole cycle. A misspelled name, an outdated insurance card or a missing authorization produces a claim that will be denied weeks later, long after the patient has left. At Lakemont, registration and eligibility errors cause about 38 percent of initial denials, the largest single category, and missing prior authorizations cause another 17 percent, concentrated in imaging and outpatient surgery. Patient access also determines how much patient responsibility is collected. Collections before or at the time of service are far more successful than those attempted after a bill is mailed, yet Lakemont collects only 22 percent of patient responsibility at the point of service. Financial counseling adds a mission dimension: patients who qualify for Medicaid or the system's financial assistance policy should be identified before their bills become bad debt.
Clinical Departments and Documentation
Physicians, nurses and therapists do not think of themselves as part of the revenue cycle, but everything that follows depends on what they document. Under fixed per-admission payment, the specificity of diagnoses determines which payment group a case falls into, and missing documentation of the severity of a patient's illness means the hospital is paid for a less complex patient than it treated. Documentation also supports medical necessity: an order without a documented reason, or an admission without evidence of why inpatient care was needed, invites denial. Lakemont's clinical documentation integrity team of four specialists reviews about 60 percent of Medicare inpatient cases concurrently and sends queries when the record is unclear. Clinical departments also drive charge capture. When supplies, drugs or procedures are delivered but not entered, the service is simply never billed, and the system's internal audits find missed charges most often in the emergency department and procedural areas.
Health Information Management and Coding
Health information management translates documentation into codes, and its speed and accuracy affect both cash flow and compliance. The system's discharged not final billed figure of 7.4 days means that about a week of inpatient revenue is waiting for coding or for missing documentation at any time, mostly because physicians have not signed discharge summaries or answered queries. Coding accuracy works in both directions. Undercoding loses legitimate payment, while overcoding creates repayment obligations and legal risk. Coding is also costly; a cross-national study found that high coding costs are a main reason billing and insurance-related costs are higher in the United States than in most comparable nations (Richman et al., 2022).
Case Management and Utilization Review
Case management decides whether a hospital stay is billed as an inpatient admission or as outpatient observation, a distinction that can change Medicare payment for the same patient by thousands of dollars. It also manages length of stay, which matters under fixed payments because each extra day adds cost without adding revenue, and it obtains authorizations for continued stays from Medicare Advantage and commercial plans. These plans are now Lakemont's main source of medical necessity denials. The federal inspector general reported that in its sample of prior authorization denials by Medicare Advantage plans, 13 percent involved requests that satisfied Medicare coverage rules, care traditional Medicare would probably have covered (U.S. Department of Health and Human Services, Office of Inspector General [OIG], 2022). Case managers therefore must document the clinical basis for each admission carefully and be ready to support appeals.
Patient Financial Services
Patient financial services submits claims, posts payments, follows up on unpaid accounts, works denials and bills patients. It is the department most often blamed for poor revenue, but much of its workload is created upstream. Denials are expensive to rework, and payer rules vary; an analysis of remittance data put the denial rate for fee-for-service Medicaid 17.8 points above that for traditional Medicare (Gottlieb et al., 2018). At Lakemont, 52 days in accounts receivable reflects both slow denial follow-up and a backlog of small-balance accounts. The cost of this work is significant: a study at an academic health system estimated billing and insurance-related costs of 124 dollars for a general medicine inpatient stay and 215 dollars for an inpatient surgical stay (Tseng et al., 2018).
Where the Largest Losses Originate
Ranking the departments by their current effect on reimbursement produces a clear order. Patient access has the largest effect, because its errors drive the biggest share of denials and its low point-of-service collections increase bad debt. Clinical documentation and health information management come next, because they determine both the level of payment and the speed at which claims are sent. Case management is rising in importance as Medicare Advantage denials grow. Most of the revenue lost at the end of the cycle is lost at the beginning, in the front office and the medical record, not in the billing office. Milestone Two will build on this analysis by examining the system's billing processes, the role of marketing and its reimbursement methods, and the final white paper will recommend changes for each department.
References
Casto, A. B., & White, S. (2021). Principles of healthcare reimbursement and revenue cycle management (7th ed.). AHIMA Press.
Gottlieb, J. D., Shapiro, A. H., & Dunn, A. (2018). The complexity of billing and paying for physician care. Health Affairs, 37(4), 619-626. https://doi.org/10.1377/hlthaff.2017.1325
Richman, B. D., Kaplan, R. S., Kohli, J., Purcell, D., Shah, M., Bonfrer, I., Golden, B., Hannam, R., Mitchell, W., Cehic, D., Crispin, G., & Schulman, K. A. (2022). Billing and insurance-related administrative costs: A cross-national analysis. Health Affairs, 41(8), 1098-1106. https://doi.org/10.1377/hlthaff.2022.00241
Tseng, P., Kaplan, R. S., Richman, B. D., Shah, M. A., & Schulman, K. A. (2018). Administrative costs associated with physician billing and insurance-related activities at an academic health care system. JAMA, 319(7), 691-697. https://doi.org/10.1001/jama.2017.19148
U.S. Department of Health and Human Services, Office of Inspector General. (2022). Some Medicare Advantage organization denials of prior authorization requests raise concerns about beneficiary access to medically necessary care (OEI-09-18-00260). https://oig.hhs.gov/oei/reports/OEI-09-18-00260.asp
How this HCM 345 Module 3 example is structured
The draft is built around the revenue cycle because that is how reimbursement actually flows through an organization. It opens with the organization and its payer mix. A table of revenue cycle indicators shows where the system stands. Each department then gets a section describing its role in the cycle, how its work helps or harms reimbursement, and the evidence behind that effect. A closing section ranks the departments by their current impact and sets up Milestone Two.
Get HCM 345 Module 3 written to your instructions
Share your HCM 345 Milestone One guidelines, rubric and the organization you chose. A draft analyzing how its departments affect reimbursement comes back within 24 to 48 hours, and your first is free. The paper above is an original model document written by our desk, not a submitted student paper and not an official Southern New Hampshire University document.
HCM 345 Module 3 questions, answered
What does HCM 345 Milestone One require?
Milestone One of the final white paper usually asks for a draft analyzing how the departments within a chosen healthcare organization affect reimbursement. Students typically describe the revenue cycle, explain the role of departments such as registration, clinical services, health information management and billing, and show how each can increase or reduce payment.
What is the revenue cycle?
The revenue cycle is the sequence of administrative and clinical steps that turns a patient encounter into payment: scheduling and registration, insurance verification and authorization, care delivery and documentation, charge capture, coding, claim submission, payment posting, denial management and patient collections.
What does DNFB mean?
DNFB stands for discharged not final billed. It measures the value of accounts for patients who have left the hospital but whose claims have not yet been sent, often because coding or documentation is incomplete. It is usually expressed in days of average revenue, and a rising figure means cash is being delayed.