Healthcare Revenue Cycle Process

Gear set for Healthcare Revenue Cycle Process 6 Best Practices

The healthcare revenue cycle process is a non-organic process – non-organic because steps cannot be reversed, skipped or circumvented to save time or collect money faster.

Missing or skipping a step can mean late payments from insurers and even non-payment. When working through the revenue cycle process best practices are essential benchmarks for success.


Healthcare Revenue Cycle – 6 Basic Steps

Just six essential steps are to be included in a complete revenue cycle process:

  1. Scheduling the appointment or the initial point of contact between your clinic or practice and the patient. During this crucial first step, you collect insurance information and other important details about the potential patient. But it’s also important to verify the information, especially on the day of that patient’s appointment. Between the first contact and appointment day, insurance coverage can change.
  2. Patient portions should be collected at the time of service, which speeds up your revenue cycle. If, for example, most patients wait for the bill to come in the mail, you have the added task of collecting late payments or no payment at all. This adds up quickly in your loss column.
  3. Charges and fee schedule are the most critical step in the revenue cycle process in medical billing or revenue cycle billing for services. You must make sure that the fee schedule, especially in connection with government-sponsored insurance plans, is in line with government policy, which is constantly in flux. Charging on the correct schedule brings revenue in a timelier manner.
  4. Following up on denied or late claims are critical to your revenue cycle. Most moderately busy medical practices submit claims constantly, and any resubmitting is officially late.
  5. Payment posting should be immediate and constant to keep the healthcare revenue cycle flowchart in constant motion. Think of the flowchart as a wheel of steps, a wheel that must continuously turn.
  6. Delinquent collections happen during breakdowns when key points in your revenue cycle go awry, when something is missed or when the flowchart wheel stops turning. Lax follow-up on claims or misinterpretation of schedules are often the culprits. Unfortunately, delinquent collections, when turned over to a recovery agency, can eat into your profits.

We recommend an audit of your healthcare revenue cycle process, at the very least. You are finding where missed steps or errors in billing have occurred the fastest and, in the end, the least expensive way to turn your sluggish revenue cycle around.


Healthcare Revenue Cycle Process – 13 Detail Steps

While the revenue cycle process may seem complicated, it can be broken down further into 13 more detailed steps.

  1. Scheduling appointment
  2. Pre-registering patient for services by verifying information
  3. Registration through data collection and the creation of a medical record that meets regulation
  4. Patient portion collection
  5. Translating services into billable fees
  6. Coding correctly to ensure collection of billable fees
  7. Revenue cycle billing for services
  8. Payment posting
  9. Follow up for claims denied or late payments
  10. Utilizing collections or a collection agency
  11. Running regular reports to look for gaps in the flowchart
  12. Shoring up these gaps
  13. Starting the process again with gaps filled

What is another name for revenue cycle process in a physician office? Simply, it is called medical billing. Revenue cycle process management, however, is a more apt description because collecting revenue in a healthcare setting is far more complicated than merely billing and collecting.  A best practices checklist is a good start!

A revenue cycle gap analysis will be most helpful if done periodically and regularly, because the rules are always changing, because errors in coding can mean non-payment, and because the flowchart wheel must never stop turning.

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