The healthcare revenue cycle is more than just collecting bills and is a pillar of a successful organization. Let’s take a look at the Basics of the Healthcare Revenue Cycle.
There are a number of different processes that go into running a successful healthcare organization. Regardless of whether you are a multi-location hospital network spread across the country or a private practice consisting of one doctor and one nurse practitioner, revenue cycle management is one of the most critical processes that organizations need to master to be successful.
Revenue cycle management (RCM) is the process that handles claims processing, payment and revenue generation. In the simplest terms, it is a health care organization’s financial circulatory system. It is the administrative function that comprises the capture, management, and collection of patient service revenue. It is the entire life cycle of a patient account.
RCM includes the use of technology to keep track of any claim through its entire lifecycle, ensuring payments are collected and addressing any denied claims. The ultimate goal allows health care providers to follow the process and address any issues quickly, allowing for the steady stream of revenue.
A system running effectively prevents denials of claims and maintaining a visible, efficient billing process. RCM also encompasses everything from determining patient insurance eligibility and collecting co-pays to properly coding claims using ICD-10. one of the very Basics of the Healthcare Revenue Cycle.
A streamlined and efficient revenue cycle is one of the pillars of a successful health care organization. However, one that lacks efficiency, the proper skill set of staff and effective denials management can negatively impact the healthcare facility’s bottom line.
To do this successfully, organizations need to consider coding of diagnostic services or procedures. The narrative and statements become coded data that can be collected, stored and manipulated for internal and external purposes.
The basic steps include:
=> Point of service registration counseling collections
=> Encounter Utilization Review and case management
=> Charge capture and coding
=> Claim Submissions
=> Third Party follow-up
=> Remittance processing and rejections
=> Payment posting, appeals and collections.
Clearly, the revenue cycle is more than just ensuring the end balance on any account is zero. It starts the moment a patient calls to make an appointment and ends when everything is collected. And that is the Basics of the Healthcare Revenue Cycle.
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