Revenue Cycle in the Healthcare Industry
The healthcare industry revenue cycle is the most complicated compared to the other industries. The process essentially begins with the patient getting registered into the healthcare facility, providing treatment to the patient, and ends with the hospital or the healthcare provider receiving full payment for the services rendered. In most scenarios, the health insurance companies are involved, mainly when a significant expenditure is involved in medical treatment. The healthcare systems use the revenue cycle management to trace revenue from patients from their encounter with the healthcare system or initial appointment to their balance payment (Rauscher & Wheeler, 2008). There are seven basic steps involved in the healthcare industry revenue cycle and are explained as follows.
This is where the process begins and is the most critical step in the whole revenue cycle process. This step allows for capturing demographic information by the medical practice, ad insurance information coupled with the patient's eligibility. This is usually done through a clearinghouse, and on most occasions, when the patient is still on call. The information obtained is taken to the patient's insurance carrier. The information also flows through the management system of the provider practice and informs the provider about the patient's co-payment, co-insurance, deductible, and coverage, and in some cases, if a referral is needed.
During this process, the practice discusses the patient's financial expectations and includes the cancellation policy and time of payment. This process is essential because it enables the provider to set the financial tone or requirements initially. This prevents any questions that may arise regarding payment. Should a practice lack a tight pre-registration process, many areas are bound to get missed. Therefore, it is recommended that the practice always check the pre-registration process to strongly start the revenue cycle process (Mindel & Mathiassen, 2015).
This process helps to solidify the accuracy of information about patients from the beginning to the end. During this process, the provider must ensure that the patient's details, including insurance information, guarantors, the fate of birth, phone number, and address, are accurate. It is also critical that this data must be secured every time a patient receives treatment. Also, the provider has to collect co-payment during this stage. If it is a specialist, they have to ensure that authorization or a referral is in place for the patient (Rauscher & Wheeler, 2008). If this step is not done in a specialist's office, they are likely not to get paid for that service in the end. Furthermore, this is the step in which financial firms are signed together with any insurance benefits. The risk associated with skipping this crucial step is financial repercussion, especially if an audit is done on the practice.
This process can take various forms. First, the process can be automated, meaning that information or data…the signs of danger or the red flags are not submitting a claim on time, no referral on file, and no authorization (Callahan, 2008). Another element under this process is the fee schedules. Failure to evaluate the fees by the providers can cause some money to be left on the table.
In this revenue cycle process step, the practice looks at what has been paid out and what has not been paid. The accounts receivable report contains the patient and insurance account for a specific period. Should the insurance follow-up be broken and the payment delays, it will be reflected in the account receivable report. When structuring the report, various questions include whether the billing team has been cross-trained and if there are people assigned to specific carriers, among others.
This is the hardest part of the revenue cycle process. Usually, the best time to get money out of the patient is presumably when they are in the provider's office. Therefore, it is vital to ensure the proper training of the organization's front desk staff to collect the payment at the service time. This process is of equal importance as ensuring that the patient financial statements go out. This can be achieved by making a daily statement. Cleaning up the patient collection also helps with removing the necessity to bring a bill collector. The central importance of this process is that it helps with collecting…
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