healthcare revenue cycle management:

Understanding Healthcare Revenue Cycle Management


Despite its daunting name, healthcare revenue cycle management refers to the process through which payment is provided for rendered medical services, and its aim is for physicians to get paid in a timely fashion. The cycle begins when a patient calls to schedule an appointment and ends after they have received medical attention and paid their bill in full.

Many clinics lack the resources to request insurance information during the patient’s initial call, though it should be the first step in a successful revenue cycle management plan. By doing so, staff can run insurance information before the visit and find out whether the patient is covered, what services their plan covers, and what their co-pay is. If there are any discrepancies, such as the patient’s policy having expired, it’s best to catch it early on so that the patient can be made aware before the appointment date. This also benefits healthcare providers in that they can postpone the appointment until discrepancies are rectified, or they can arrange alternate payment options with the patient beforehand. Clinics may choose to outsource this task to outside professionals, leaving staff to worry about other duties that affect patient care.

Since obtaining partial or incorrect insurance information will throw off any subsequent steps in the revenue cycle, it is important to get things right the first time. The second step involves posting charges with their corresponding diagnoses codes. This means that it is crucial for CPT and ICD codes to be entered correctly. While it is common practice for some clinics to hold their charge slips a few days before posting them in order to ensure that there are no missing charges, doing so creates a delay in final billing and is highly discouraged. Instead, electronic claim submission and remittance can enhance the revenue cycle process, allowing staff resources to be used elsewhere.

If carried out correctly, a good healthcare revenue cycle management process can help maximize profits and office efficiency by leaving billing issues to the experts.

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