Revenue Cycle of a Healthcare Practice: An Essential Guide

Successful medical practices balance between business objectives and expert patient care. This way, patient health and quality of life are improved. But when providers fail to meet the demands of their field, it can negatively impact the customer service experience. 

Customer Satisfaction 

Nowadays, health care consumers have a variety of options that they can resort to for their medical concerns, like choosing to visit a walk-in clinic or have a virtual session instead. Regardless of the method, medical practices that deliver patient loyalty and rapport are the ones that provide outstanding customer satisfaction. 

Administrative Function 

The organizational hierarchy of the healthcare system consists of operational and clinical tasks devoted to patient services. Each department serves a purpose, but customers are mainly involved in billing. Their finances go through something called a revenue cycle. But what is revenue cycle management (RCM) exactly? To put it simply, it’s the patient billing cycle from start to finish. Let’s take a look at the process.  

  1. Preregistration

Firstly, demographic and insurance information is verified. Data accuracy is vital since it has to be secured throughout the cycle. Patients should attend to the procedures in this process as they may not get paid for the provided services in the end. This often happens when they fail to discuss co-payments that have to be authorized. They must also fill out the required information on the financial forms in order to gain their insurance benefits.

  1. Registration

Here, finances are discussed. Patient information and insurance coverage is provided. Likewise, eligibility, referrals, and billing inquiries are set. This step is vital in ensuring that provider policies are informed. Customers will know what to expect regarding the restrictions and leniencies of their healthcare providers while the management system documents the patient’s deductibles and co-payments.

  1. Charge capture

Charge capture can be documented in 2 ways. The billing information can be automated through the management system, or it can be manually registered. All of the revenue is accounted for through a financial advisor using a coding system based on the patient’s insurance carrier. 

  1. Claim submission

Only after the billing has been entered during charge capture can the information be sent to the customer’s insurance carrier. The insurance codes are processed and claims are sent to different payers. Then, a transmission report is generated to show the status of the claims. 

  1. Remittance processing

Once the claims are sent, remittances are received. The healthcare providers are paid for their services based on their agreements with the insurance carriers, known as allowables. The contract is negotiated between the two parties and the insurance company confirms the service payments. 

  1. Insurance follow-up

In this phase, the practice evaluates the revenue. Billing is viewed through an accounts receivable report which shows if a patient or insurance is missing a payment (a broken insurance follow-up) and the reasons for the delay. 

  1. Patient collections

Finally, the patient’s money is collected in office at the time of service, and statements are made for any remaining balance. That’s why implementing payment policies can help with the accumulation of due amounts getting out of control. 

The healthcare system is made up of an extensive and intricate structure. There are different divisions that comprise the unit. The RCM is a process involved in patient billing and there are 7 steps through which revenue is managed. 

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