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The revenue cycle consists of seven steps: preregistration, registration, charge capture, claim filing, remittance processing, insurance follow-up, and patient collection. This article outlines a brief overview of these seven steps of the revenue cycle.
Fremont, CA: Revenue cycle management is how healthcare systems in the United States track revenue from patients from their first appointment or engagement with the healthcare system to payment of the balance.
The revenue cycle begins with the appointment or hospital visit and concludes when the provider or hospital is fully compensated for the services delivered. Here is an outline of the steps involved in the revenue cycle:
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Preregistration
Preregistration is the initial and most critical phase in the revenue cycle process. Preregistration enables the medical practice to collect demographic information, insurance information, and eligibility in real-time via a clearinghouse, frequently while the patient is still on the phone. Information is sent to the patient's insurance company and routed through the physician's practice management system, which then informs the provider of the patient's coverage, deductible, co-insurance, co-payment, and, sometimes, if a referral is necessary.
Registration
Registration formalizes ensuring that the patient's information is completely accurate from start to end. During registration, the physician confirms that the patient's address, mobile number, date of birth, guarantors, and insurance details are valid. It is vital that this data is safe each time a patient is treated.
Charge Capture
Charge capture, the third phase in the revenue cycle, can be done in various ways. It may be automated such that the information flows automatically into the practice management invoicing side based on what the provider enters in their paperwork. The second alternative is the traditional method, in which front-desk workers enter information or transmit it to billing, where it is manually entered.
Claim Submission
After the charges have been entered, information is sent to the insurance company to submit the claim. The revenue cycle team will examine the charges, CPT, and diagnostic codes. They will inquire whether the diagnostic will support the surgery done. If two services are given, they must be segregated and properly coded.
Remittance Processing
The fifth step in the revenue cycle is remittance processing. Remittances will be returned to a practice once its claims have been issued. The benefits explanation shows the practice and how much it was paid for the services given. Allowables are decided during the procedure. The fees the provider and insurance company agree upon for a given service are allowable. The provider and carrier negotiate the contract, and the insurance company confirms the amount it will pay for each service.
Insurance Follow-Up
The next phase in the revenue cycle is insurance follow-up. At this step, practices consider what has been paid and what has not.
The accounts receivable (A/R) report reveals anything that has been sitting in the insurance or patient buckets for some time. This report will demonstrate if insurance follow-up is failing and why payment is taking so long.
Patient Collections
Patient collections are the most demanding aspect of the revenue cycle. When a patient visits your office, collecting money from them is the greatest moment. As a result, it is advised that front desk personnel be educated to gather at the point of service. To avoid a collections backlog, ensure a uniform strategy for collecting co-payments and deductibles that establishes the practice's financial expectations.
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