The majority of the hospitals and healthcare systems use the healthcare revenue cycle to manage their clinical and administrative data coming into the hospitals every day. However, the revenue cycle management process can be complex even for hospitals using proper management software as the data gets threaded to multiple departments. Therefore it is essential to ensure that you are receiving the most accurate data for successful management. The Healthcare revenue cycle involves executing all administrative & clinical functions that contribute to the administration, capture & collection of patient service data. In short, it refers to the entire cycle of a person’s account, from registration to the payment of the bill.
The revenue cycle contains a list of specific responsibilities helpful in maintaining order. Below, we provide the list of 9 steps of revenue cycle management used by healthcare professionals to grow & maintain their revenue stream.
This step of revenue cycle management & is exceptionally crucial as it can provide substantial financial benefits to both parties. Suppose we see this from the patient’s perspective. In that case, it does not only help in saving time in filling out the forms so that they can see the doctor as fast as possible, but it also lets them know the out-of-pocket costs ahead of time to avoid unexpected charges on their bill.
If we see this from the hospital’s perspective, letting patients know their out-of-pocket costs ahead of time increases the likelihood of payment on time, eliminating bad debts from the hospitals. In addition, pre-registration usually includes collecting patients’ information like name, medical history, demographic info, insurance & payment communication, which helps streamline the process and increase patient satisfaction.
The second step validates the required information of patients gathered during the pre-registration stage. If the hospital finds any error in the registration form that a patient fills out, this is the stage to bring it to the patient’s attention before it becomes a more significant issue.
3) Capturing of charge
Here the charges get captured on the bill & then submitted to the insurance service provider. This step is essential to ensure that hospitals get fully reimbursed by the payers throughout the revenue cycle.
4) Reviewing utilization
This step is used to confirm that the plan provides the necessary coverage for your medical services. In addition, it helps the company in reducing the costs & in determining if the recommended treatment is appropriate.
Today, hospitals & health systems have a vast range of health services and pharmaceuticals. Therefore, coding becomes essential to turn written descriptions of items, services, procedures, & patient conditions into alphanumeric and numeric codes. These codes might not be relevant to the patients, but it helps hospitals to map out the process. The medical billers then use these codes to create bills & insurance claims for patients.
6) Submission of claims
After coding health services into the management system, the next step involves submitting the claims by the hospitals to the insurance companies so that the payment process can take place according to the terms of the contract.
7) Processing of remittance
In this step, the account receivable staff of the hospital will analyze the payment received from the insurance provider or payer to determine if the price was approved or delayed due to an error.
8) Following up
Hospitals can now easily collect the payers’ payments according to the agreed terms during the payer contract negotiations. Most common issues faced are denials, under-payments & non-payments. If the payer’s reimbursement does not satisfy the hospital, they are most likely to adjust the rates during the next set of payer negotiations.
9) Collection of payments
This step involves the monitoring of the accounts that are outstanding & pursuing payments of those balances from patients. This step is becoming more critical as the financial responsibility continues to increase due to high deductible health plans.
Healthcare revenue cycle management is constantly evolving, and thus, it is crucial to maintain the highest level of patient-centric care. Having 20+ years of experience in providing healthcare insurance solutions, we ensure that clients have a high level of satisfaction. We will manage your hospital revenue cycle at a low cost & a reduced turnaround time. We will also analyze decreasing denials, revenue loss & increased revenue. Visit our website If you want to know more about how we can improve your hospital’s net income.
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