What You Should Know About Healthcare Revenue Cycle Management

Healthcare Tech Outlook | Wednesday, October 13, 2021

There are seven steps that help in better management of the healthcare revenue cycle.

Fremont CA: Revenue cycle management is a method used by healthcare organizations in the United States to track revenue from patients from the time they make their first appointment or encounter with the organization until they settle their debt. The revenue cycle begins with the appointment or hospital visit and concludes when the provider or hospital is fully reimbursed for the services rendered.

The Steps included in a healthcare revenue cycle are as follows:

Preregistration

The first and most crucial phase in the revenue cycle process is preregistration. Preregistration allows a medical practice to collect demographic information, insurance information, and eligibility information in real-time through a clearinghouse, frequently while the patient is still on the phone. The information is then sent to patient's insurance carrier and then passed to the physician's practice management system.

Registration

From start to finish, registration ensures the process of ensuring the patient's information is 100 percent accurate. The provider double-checks the patient's address, phone number, date of birth, guarantors, and insurance information during registration.

Charge capture

Charge capture can be accomplished in a variety of ways. It can be automated, so that information from the provider's paperwork is automatically fed into the practice management billing system. The other alternative is to do things the old-fashioned way, with front-desk workers manually entering information or sending it to billing.

Claim submission

After the charges have been submitted, claim submission comprises sending information to the insurance provider. The charges, CPT code, and diagnostic code will all be examined by the revenue cycle team. A claim will be settled much faster if it arrives at the insurance provider in good condition.

Remittance processing

Remittances will be received once a practice's claims have been sent out. The benefit explanation shows the practice how much they were compensated for the services they supplied. Allowables are determined during this process. The insurance company will then certify how much they will pay for each service after the provider and carrier have negotiated the contract.

Insurance follow up

Practices examine not only what has been paid but also what has not been paid at this time. The accounts receivable (A/R) report displays all of the items that have been sitting in the insurance or patient buckets for a length of time. This analysis will reveal whether or not insurance follow-up is broken, as well as why it is taking so long to receive payment.

Patient collections

Patient collections are the most problematic aspect of the revenue cycle procedure. When a patient is in your office, the optimum time to get money from them is when they are there. As a result, front desk workers should be educated to collect payments at the moment of service. To avoid a collections backlog from building up, make sure you have a uniform policy in place for collecting copayments and deductibles that outlines the practice's financial expectations.