IRB Number
24-0606-063-FL
Date of Award
Winter 12-10-2025
Document Type
Dissertation
Degree Name
Doctor of Education (EdD)
First Advisor
Mark Kelso
Second Advisor
Christopher Cale
Third Advisor
Kathy Wood
Abstract
Efficient Revenue Cycle Management (RCM) is essential for healthcare organizations to ensure timely and accurate reimbursement for medical claims. The research problem was the significant inadequacies in RCM process in medical billing that has resulted in financial burdens imposed on providers, patients, and the organizations that provide medical services. There are clearly identified educational gaps in RCM that contribute to claim denials, delays, and revenue loss, underscoring the need for robust training programs. The purpose of this study was to explore the perceived impact of education in RCM on medical claim reimbursement outcomes within the U.S. healthcare system. The study used Lewin’s Change Model support by Kirkpatrick’s New World Model theories to explore how education influences RCM processes and outcomes. Specifically, it sought to understand challenges in managing RCM, identify gaps in training, and evaluate the perceived impact of implementing education programs. Using a basic qualitative methodology, the research employed purposive sampling with 12 healthcare administrators, achieving data saturation through diverse and iterative responses. The participants had to have experience in healthcare administration, past or present, and be over the age of 18. Data were collected through semi-structured interviews and analyzed thematically to identify patterns and insights. Findings revealed three major themes: operational inefficiencies due to inadequate training, significant gaps in RCM knowledge, and the need for standardized, comprehensive education programs. Participants emphasized that enhanced training could improve reimbursement rates, reduce claim denials, and alleviate administrative burdens. The study recommends implementing tailored RCM education initiatives that integrate into existing workflows, supported by frameworks for sustainable organizational change. This research highlights opportunities for systemic improvement, offering strategies to enhance accuracy, and financial outcomes.
Recommended Citation
Miller, J. L. (2025). Evaluating the Perceived Benefits of Education in Revenue Cycle Management and the Impact on Medical Claims Reimbursement. [Doctoral project, University of St Augustine for Health Sciences]. SOAR @ USA: Student Dissertations Collection. https:/doi.org/10.46409/sr.CJUQ9190
Included in
Accounting Commons, Business Administration, Management, and Operations Commons, Corporate Finance Commons, Educational Leadership Commons, Finance and Financial Management Commons, Interprofessional Education Commons, Management Information Systems Commons, Management Sciences and Quantitative Methods Commons, Quality Improvement Commons, Training and Development Commons
