Medical Billing Revenue Cycle – 4 Key Takeaways

Employee working on medical billing revenue cycle using computer automation.

Authors have spilled a lot of digital “ink” lately describing the medical billing revenue cycle. We used to just say medical billing or hospital billing. Now we label it much more descriptively.

And you can take your choice of lists – describing Good, Better, or Best practices:

  • Five (5) Revenue Cycle Management Process in Medical Billing – 5 Steps,
  • Eight (8) Physician Practice Revenue Cycle – 8 Basic Best Practices,
  • Nine (9) Medical Revenue Cycle in 9 Steps,
  • Nine + Nine (9+9) Revenue Cycle Management Solutions in Healthcare – 9 plus 9,
  • or even Thirteen (13) Healthcare Revenue Cycle Process.

So instead of another list, let’s focus on an important principle that applies to the medical billing revenue cycle.  And how to apply this principle using some of the more modern electronic health record and billing/accounts receivable (AR) systems.

But however it is defined and described, it still comes down to collecting for the services a hospital or medical practice has provided.  Some things have changed that influence the process in important ways.


The Medical Billing Revenue Cycle and Automation on the Front End

Modern billing and AR systems have automated many of the labor-intensive processes involving making appointments and providing insurance information.

  • You can inquire directly into a payer’s eligibility system to verify insurance coverage and deductibles/co-payments.
  • Patients can enter their own insurance coverage on-line or via a kiosk in the office.
  • Patients can make appointments and update their insurance coverage via a patient portal.
  • The No Surprises Billing Act of 2021 requires providers to issue Good Faith Estimates to patients with scheduled appointments who have no insurance. Vendors should be updating their systems to help you issue these estimates.
  • Providers are required to make available their billed charges as well as average payments by insurance companies for a list of shoppable services. Your system should be able to furnish this information for posting on your website.


Automation of Charge Capture and Billing

For several years now, providers have been able to implement integrated systems that function as an electronic health record (EHR) as well as a patient billing and AR system. And it is also possible to interface many EHR and billing/AR systems to make a nearly seamless process possible.

  • Charge entry is highly automated. Physicians select diagnosis and procedure codes as they complete an encounter note. Hospitals use stand-alone systems to automate charges for medications and supplies. Some systems also promote the security of inventory and reduce medication errors.
  • Digital support for procedure coding and diagnosis coding is also widely available. Some systems can “read” an encounter note and give the clinician feedback on the quality of the note for procedure coding. Integration or interface between clinical and billing systems means few or no delays in getting codes on claim forms.
  • And claim forms go the way of the dodo with electronic billing. Systems have claims scrubbers to catch errors before the claims go out, reducing denials for errors. And claims go to clearinghouses via electronic transmission.


Medical Billing Revenue Cycle and Automation on the Back End

The “back end” of processes is also much more automated these days.

  • Payment posting can largely be an automated process with most payers these days.  This includes government payers as well as commercial payers. And automated payment posting is usually accompanied by electronic payment into your bank account. In fact, many payers insist on paying electronically if you have 100 or more claims per year. You can reduce your days in AR by 14 days or more just by accepting electronic payments from as many payers as possible.
  • Patients can make payments using debit or credit cards via a patient portal.  The faster they make these payments, the less time and effort spent in sending statements and making follow-up calls.
  • Managing any business requires reports, and hospitals or medical practices are no exception.  Modern systems can download reports into spreadsheet programs for more targeted analysis. Larger systems sometimes have more sophisticated report-writer applications that help you drill deeper and customize more meaningful reports.


Take Advantage of the Automation you may already have!

So what should you do with the ideas discussed above? Well, one way to approach it is to get one of the lists (or get all of them) and see where you may be missing an opportunity to automate one process or another. Print out the list(s) and ask yourself if/how your system can automate all the processes on the list. Then take whatever steps you need to implement that function.  And if you are considering a new or replacement system, make sure any new system automates as many of them as possible.

When you need proven expertise and performance

Jim Hook, MPH

Mr. James D. Hook has over 30 years of healthcare executive management and consulting experience in medical groups, hospitals, IPA’s, MSO’s, and other healthcare organizations.