Read this blog post to find out about all the steps involved in healthcare revenue cycle management and how they impact hospitals.
Hospitals, clinics and healthcare centers use a healthcare revenue cycle to manage all of their administrative and clinical data that comes into their hospital on a day-to-day basis. Revenue cycle management is not complex but it is an arduous process that involves a lot of data passing through multiple departments in a hospital. This is why getting access to accurate data is critical to successful business management. The revenue cycle management process involves the execution of all administrative and clinical functions that include the capturing, managing and collecting of patient service data. In short, it revolves around a patient’s account right from the registration to the bill payment.
Here is a list of all the functions involved in a healthcare revenue cycle, to help you understand how the system works. Healthcare professionals use these steps to grow and maintain the revenue stream of a hospital.
The first step in revenue cycle management is pre-registration that refers to the collection of information prior to the arrival of the patient. Details like name of the patient, medical history, demographic info, insurance details and payment details are collected. Pre-registration can provide huge benefits to both parties. Patients can see their doctors more quickly, instead of filling out forms and they can stay aware of their costs ahead of time. Hospitals on the other hand can expect their patients to pay their bill on time, simply by allowing their patients to see the costs for a medical procedure. This eliminates the likelihood of bad debts for hospitals. Pre-registrations help in streamlining the process and increasing the satisfaction of patients.
In this step, all the patient registration information that was collected during pre-registration is validated. If an error is noticed in the form filled out by a patient, it is brought to the attention of the patient before the error escalates into a bigger problem. Errors in a patient form can cause long delays for hospitals trying to receive their reimbursement from payers.
During this phase, charges are captured on a bill from the service provided and then submitted to the insurance provider. This step is important in the revenue cycle management, as it makes sure that hospitals get a full reimbursement from their payers. This is referred to as revenue integrity.
This is the step where health insurance companies review the request made for medical treatment. The purpose of the utilization review is to confirm that the healthcare plan offers coverage for the required medical services. It also helps the hospital to reduce costs and evaluate if the suggested treatment is appropriate.
The process of coding procedures and diagnoses is the next step. Because of the huge amount of pharmaceuticals and health services available at hospitals, coding is used to translate the written descriptions of services, procedures, patient conditions and items into alphanumeric or numeric codes. Though these codes may be irrelevant to patient, it is used to help hospitals create a map for the process. Medical billers use these codes to develop insurance bills and claims for patients.
During claim submission, the hospital will submit the claims to the insurance companies, so that the payment can be transferred successfully as per the terms of the contract. In case of errors or if the claim is not properly sent to the insurance company, there can be a delay in the hospital acquiring their reimbursed payment from the insurance company.
In this crucial step, payments are either accepted or rejected after they have been received. The A/R staff at the hospital will analyze the payment received by the insurance provider/payer and check if the payment is approved or if there is any discrepancy that is causing a delay in the payment. In case of an error, the claim would get directed to the clearinghouse where it will be reviewed and cleared so that the claim can be sent back to the payer with the correct amount of payment to be made.
This is when payments are collected from third-party insurers. Hospitals can now collect their payments from payers, both governmental and commercial as per the standings agreed upon during payer contract negotiations. Some of the most likely issues could be denials, underpayments or non-payments. In case the hospital is not satisfied with the reimbursements, they can adjust the rates when the next set of payer negotiations comes up.
In the final step of revenue cycle management, patient balances are determined and payments are collected. Accounts that are outstanding are closely monitored and the payment of those balances from the respective patients is pursued. With high-deductible health plans on the rise, patient collections are increasingly becoming more critical to the revenue of hospitals.
If you are looking for revenue cycle management services, look no further than Outsource2india. We can help your hospital with all the steps in healthcare revenue cycle management, right from the start to the finish. You can be assured of fast, accurate and reliable services on a 24/7 basis. Find out more about our revenue cycle management services.
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