Hospitals and clinics employ healthcare accounting activities to handle all of the clinical and administrative information that reaches the hospital on a daily basis. For most hospitals, the use of correct revenue cycle management tools may be an extremely complex and time-consuming procedure.
All these management tools involve a piece of massive information to route through numerous hospital departments. As a result, ensuring that you have the most reliable data is crucial to effective management.
The medical billing cycle is a sequence of carrying out all clinical and administrative responsibilities that lead to the acquisition, administration, and gathering of a patient’s medical care data.
Steps of Healthcare Revenue Cycle Management
A list of specified tasks is utilized to keep order inside the revenue cycle. Given below is a description of the main revenue cycle operations that healthcare workers employ on a daily basis to build and preserve their clinic’s revenue stream:
- Pre-registration – Entails gathering information prior to the patient’s visit.
This first stage in the accounting process is critical since it has the ability to bring significant financial benefits for the society concerned. From the client’s standpoint, it not only saves time filing paperwork but also helps to ensure their operational costs in advance, avoiding unexpected amounts at the time of invoicing. From the facility’s standpoint, allowing patients to see their overhead expenses increases the likelihood that they will pay their bills on time.
- Enrolment – To collect and check patient information.
This stage confirms the patient registration information collected during the previous phase. If the clinic finds an issue in the application form, it notifies the person before the mistake becomes a larger problem.
- Cost Capture – Process of converting healthcare services into chargeable costs.
Costs from the treatment are recorded on the invoice and then sent to the health insurer in this phase. This phase is necessary to guarantee that facilities receive full reimbursement from payers.
- Usage Review– Demand for medical care reviewed by a health insurance provider
The goal of the evaluation is to ensure that the plan covers your medical treatments.
- Coding– Correctly coding diagnosis and procedures.
Given the broad array of health services accessible in today’s hospitals, coding is required to convert written descriptions of operations, services, objects, and patient situations into numeric codes.
- Claim Filing – To submit insurance claims for billable expenses.
Following coding, hospitals must send claims to insurance providers so that payments can be handled in line with the agreement of the deal. If a fault appears, it might result in a significant delay in hospitals receiving reimbursement from health insurers.
- Reimbursement Processing– Process of accepting or refusing payments once they’ve been received
In this phase, hospital personnel examines the revenue sent from the insurance company to see whether the transaction was authorized or if there was a delay in payment.
- Insurance Follow-up – Receive reimbursement from third-party insurance.
Throughout this stage, hospitals accept money from insurers in accordance with the provisions decided upon during payer agreement discussions.
- Patient Collections – Calculating patient debts and collecting payments.
This method entails keeping track of receivable amounts and chasing reimbursement from patients.
This was all about the need and steps involved in the revenue cycle management. Being informed can actually be a smart decision when it comes to financial transactions.