Healthcare Revenue Cycle

1
Healthcare Revenue Cycle
BEGIN schedule patient and pre-register
registration, financial counseling, collection of
patient amounts
accept/reject payment, post to patient account
error can occur at any point in the cycle
service is provided to patient, with utilization
review and case management ongoing
review rejected claims, follow up for clean
claim
capture all charges and code for billing
submit claim to payer ASAP!
2
Healthcare Revenue Cycle

• aggressive pricing knowledge of existing payer
  contracts is key
• requires accurate information at each point,
  constant comparison of cycle performance to
  industry standards
• patients should not be scheduled without knowing
  their payment source (emergencies are not
  scheduled)
• patients should not be scheduled if they do not
  pay their deductible coinsurance
• utilization review and case management must be
  ongoing during patient services to limit provider
  costs and comply with payer contracts
• all staff must be cost conscious while providing
  patient services, post-service billing must be
  QUICK!
• payer denials or underpayments must be
  aggressively disputed
• Most important this process must be seen by the
  patient as patient friendly