5 Steps of Healthcare Revenue Cycle Flowchart

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Healthcare Revenue Cycle Flowchart in 5 Steps

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Medical Billing RCM Flow Chart

• Healthcare revenue cycle management is a complex
  and complicated process that can drain resources
  when not properly managed. It takes considerable
  time and expertise to create and manage a
  well-maintained system that runs efficiently. An
  effective healthcare revenue cycle
  process maximizes organizational profits and
  keeps revenues pouring in. Medical professionals
  currently spend more valuable time and resources
  on the revenue cycle than any other industry. A
  healthy medical revenue cycle process works in
  tandem with other software and automates the
  revenue cycle management.
• It also aides in the migration to value based
  reimbursement, and it maximizes organizational
  performance and regulatory compliance while
  minimizing the cost per claim. The best way to
  examine the process is with a healthcare revenue
  cycle flowchart.

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Healthcare Revenue Cycle Flowchart

• The revenue cycle starts when a patient makes an
  appointment for services, and it continues until
  full payment has been remitted. While the
  healthcare revenue cycle flowchart is unique to
  each organization, some fundamental
  characteristics remain unchanged.
• For instance, every healthcare revenue cycle
  flowchart has five sections. Of course, the names
  will vary between organizations, but the general
  contents of each section remain the same. Some
  flowcharts are, however, more detailed than
  others. The five main sections of the healthcare
  revenue cycle flowchart include pre-claim,
  front-end, transactional and back-end.

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1. Pre-Claim

• The pre-claim section of the healthcare revenue
  cycle is the smallest section. However, it is
  still inherently important to the rest of the
  process. This section includes things such as
  provider credentialing and contract
  negotiations. EDI and ERA enrollment fits into
  this section along with the pricing and fee
  schedule for the organization. EDI is an acronym
  for Electronic Data Interchange, and ERA stands
  for Electronic Remittance Advice. These are both
  critical for regulatory compliance and claims
  processing.

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2. Front End

• The front-end section of the healthcare revenue
  cycle flowchart begins with the patient
  appointment and continues until the end of the
  patient visit. It includes everything from
  patient registration to deductibles, coding and
  charge capture. This part of the process is
  crucial to the rest of the healthcare revenue
  cycle. This is where a patients contact
  information is documented, and current insurance
  coverage is verified. Co-pays and deductibles are
  also collected at this point. A best practices
  revenue cycle process also includes payment
  arrangements for any outstanding balance that may
  not be covered by insurance.

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3. Transactional

• The transactional section of the healthcare
  revenue cycle flowchart includes everything from
  charge entry to cash reconciliation. This also
  includes posting payments, claim scrubbing and
  EFT processing, among other things. This is where
  charges are entered into the system, claims are
  submitted, and payments are posted for services
  rendered. It is the largest and most crucial part
  of the healthcare revenue cycle flowchart. A
  mistake in this section of the revenue cycle can
  cost the organization dearly, resulting in slow
  payments or the denial of claims. Regulatory
  compliance is also crucial in the transactional
  section of the flowchart.

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4. Back End

• The back end of the revenue cycle management
  process flow chart includes things such as
  checking the status of claims, patient statements
  and analyzing claim denials. Claims may be
  resubmitted for payment and patients need to be
  contacted to make payments on an outstanding
  balance. This is where appeals are submitted when
  necessary, and patients who refuse to pay may be
  sent to collections. The back-end section of the
  rcm cycle flow chart is where additional revenue
  is captured beyond the transactional section.

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5. Efficiency

• A healthy revenue cycle is efficient. It helps
  streamline the revenue collection process while
  promoting regulatory compliance and minimizing
  costs. It also ensures an organization is
  collecting the maximum amount of revenue
  available for their services. Utilizing a
  healthcare revenue cycle flowchart helps
  organizations isolate inefficiencies in the
  process. It allows them to target specific
  elements of the revenue cycle that need
  improvement. The reference to key indicators and
  benchmarks of best practices are essential! As
  healthcare revenue cycles become more complex,
  they present core challenges that require an
  innovative approach.  Your best next step may be
  a medical billing, to identify the gaps in
  completing the revenue cycle flowchart.