What is Revenue Cycle Management in Healthcare?
Revenue cycle management is the cycle utilized by medical services frameworks in the US to follow income from patients from their underlying arrangement or experience with the medical care framework to their installment of equilibrium.
Revenue cycle management begins with the arrangement or emergency clinic visit and finishes when the supplier or clinic gets compensated completely for the administration given.
The seven stages of the revenue cycle incorporate preregistration, enrollment, charge catch, guarantee accommodation, settlement handling, protection follow-up, and patient assortments.
Healthcare Revenue Cycle Management Flow Chart
Preregistration
Preregistration allows the medical practice to capture demographic information, insurance information, and eligibility in real time through a clearinghouse, often while the patient is still on the phone. Information goes to the patient’s insurance carrier and flows through the provider’s practice management system, then tells the provider the patient’s coverage, deductible, co-insurance, co-payment, and in certain instances, if a referral is needed.
The pre-registration process allows a practice to set the financial tone at the beginning and prevents questions about payment. Check your preregistration process to get your revenue cycle process off to a strong start.
Registration
Registration solidifies the process of ensuring the patient’s information is 100% accurate from start to finish. During registration, the provider makes sure the patient’s address, phone number, date of birth, guarantors, and insurance information are correct, and it’s critical they secure this data each time a patient is treated.
During registration, the provider collects co-payments, and if it’s a specialist, they will ensure a referral or authorization is in place to treat the patient. If that step is missed in a specialist’s office, it is unlikely they will get paid for that service in the end. During registration, financial forms are signed, and insurance benefits are assigned.
If you are unsure about your registration process, consult an expert to review it. Making sure step two in the revenue cycle process is clean and thorough will save you headaches in the long run.
Charge Capture
Charge capture, step three in the revenue cycle process, can be done in a couple of different ways.
One commonly missed charge includes ancillary services, which results in revenue left on the table. To prevent missing charges, make sure you are coding charges and getting them to the insurance carrier correctly.
If you are concerned that you may not be accounting for all charges, consult an expert to review your charge capture process. As part of a revenue cycle audit, an experienced advisor can follow a charge from start to finish, uncover missing charges, and identify miscoded charges. Making sure you are capturing your charges correctly is an important piece of the revenue cycle process.
Claim Submission
The revenue cycle team will look at the charges, the CPT code, and the diagnosis code. They will ask whether the diagnosis will support the procedure performed.
Claim scrubbing is the process of making sure claims are clean and going in the door correctly.
The transmission report shows claims sent, claims coming back in, and claims dropped, while the rejections report identifies incorrect codes. Make sure you review both reports as part of the claim submission process.
If you have questions about the claim submission process, consult an expert to help you sort it out.
Remittance Processing
Step five in the revenue cycle is remittance processing. Once a practice’s claims have gone out, they will get remittances back. Allowable is what the provider has contracted with the insurance carrier on a service provided.
Red flags include no authorization, no referral on file, and a claim not submitted in a timely manner.
There are multiple points in the remittance process that can affect your revenue cycle. If you are unsure about your remittance process, consult an expert to do a deep dive.
Insurance Follow-up
The next step in the revenue cycle process is insurance follow-up.
The accounts receivable (A/R) report shows everything that’s sitting in the insurance and/or patient buckets for a period of time.
An important piece of insurance follow-up is determining the structure. Questions to ask include: Is your billing team cross-trained?
Is the practice management team working on this insurance? Are you seeing any noticeable changes in the aging monthly?
Patient Collections
The most difficult part of the revenue cycle process is patient collections. The best time to get money from a patient is when they are in your office.
Clean up your patient collections so you don’t have to bring in a bill collector. If you are having trouble with your process, consult an expert for help.
If you are struggling with any part of your revenue cycle process, consult an expert to review the steps.
