Steps In Revenue Cycle Management

8 June 2021
Important Steps In Revenue Cycle Management

9 Significant steps in Revenue Cycle Management

Hospitals, clinics, and healthcare centres use a healthcare revenue cycle to control all of their clinical and administrative information that comes into their hospital on a day-to-day basis. Revenue cycle management isn't complex, but it's an arduous process that involves an excellent deal of knowledge passing through numerous departments during a hospital. this is often the rationale why getting access to accurate data is critical to successful business management. The revenue cycle management process depends on executing all policy making and clinical functions that include the capturing, steering, and collecting of specific service information So, it covers everything from the patient registration to the collection of payment of the invoice.

The Healthcare revenue cycle has a set of functions which helps you to get an insight on the system works.

1. Patient Pre-registration

The first step is always crucial as it starts even before a patient get enrolled in the system. Patient’s data include Name, medical history, payer details, and payment mode are collected. These information are collected prior to first visit of the Patient to the hospital. Pre-enrolment helps both the patient and the provider. It not just saves time for the patients before they counsel their doctors yet additionally guarantees straight forwardness in remaining mindful of the costs already. As for the hospitals, since the payment information is communicated to the patients, they can expect their patients to pay their bill on time by reducing the probability of bad debts for the healthcare provider. Pre-enrolment helps in streamlining the process and increase the overall patient experience.

2. Patient Registration

During the registration process, all the patient information gathered during the earlier pre-registration is supported. If an error is detected from the form filled out by a patient, it is brought to the patient's attention before the error escalates to a more significant issue. Errors in a patient form could cause long delays for hospitals trying to receive their compensation from payers.

3. Charge entry and capture

This is the phase wherein the healthcare providers record the information of their various services to the patients and then send the charges to the insurance companies. This measure is important from the revenue cycle management, as it makes sure that hospitals receive full compensation from their payers. This is known as revenue integrity.

4. Utilization management

This is the step in which health insurance companies examine the request made for medical therapy. The purpose of the utilization review will be to confirm if the health care plan provides coverage for the essential medical services. Additionally, it assists the hospital to lower costs and evaluate if the suggested treatment is appropriate.

5. Medical Coding

The practice of communicating procedures and diagnoses is another step. Because of the huge number of pharmaceuticals and health services offered at hospitals, coding is used to translate the written descriptions of services, processes, individual requirements, and items into alphanumeric or numeric codes. Though these codes could be irrelevant to individual, it is used to help hospitals create a map for the process. Medical billers use these codes to come up with insurance bills and claims for healthcare providers and patients.

6. Claim submission

Medical insurance claim submission is one of the crucial steps in medical billing. During claim entry, the hospital will submit the claims to the insurance companies so that the payment may be transferred as per the details of the contract. In the occurrence of mistakes or in any other challenges in the claim submission to there would be delays in the payment processing and the health care providers receivers the claim amount.

7. Denial management

In this vital step, payments are either accepted or rejected after claims have been received. The A/R staff at the hospital analyses the payment received from the insurance provider/payer and assess if the payment is approved or is there a discrepancy which is causing a delay in the payment. In the event of a mistake, the claim could get directed to the clearinghouse in which it is going to be assessed and cleared so that the claim could be routed back to the plaintiff with the correct quantity of payment to be made.

8. Insurance follow-up

It is estimated as per American Medical Association (AMA) that 1 out of 5 claims is processed inaccurately, leaving the health care industry only 80% of accuracy rate in processing and paying claims. This determines the importance of Insurance follow ups in receiving the claims correctly. Some of the most probable issues in this step may be denials, underpayments or non-payments. In the event of hospital not being satisfied with the reimbursements, they can adjust the rates when the next set of plaintiff negotiations that come up.

9. Patient Billing and Collections

In the last step of revenue cycle management, patient balances and obligations are calculated, and a statement is prepared. Outstanding accounts are carefully tracked. The payment balances of various patients are followed-up. With high-deductible health programs on the increase, patient ranges are becoming more crucial as it is directly proportional to the earnings of hospitals.