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Healthcare Revenue Cycle

Basics of Healthcare Revenue Cycle Management

Saving as many lives as possible and treating the maximum number of patients are noble causes and aims for the physicians, surgeons, and all other healthcare professionals. The pharmacies, the imaging centers, the intensive care units and all other areas of the medical industry are built on the idea of saving as many lives as possible.

To achieve this noble cause, we need new techniques, tools, and a seamless financial management system to deal with chronic conditions, acute patient distress, and inevitable medical emergencies. Not only does this improve the patients’ experience, but it also helps the medical industry run smoothly.

Herein, revenue cycle management is all about managing the administrative tasks, payments, financial processes, claim processes, billing, coding, and revenue collections with great efficiency and accuracy. Implementation of an effective, efficient healthcare revenue cycle management service – like those provided by Avosina Medical Technologies —  is critical to meet the needs of a healthcare organization’s finances.

The process regarding the healthcare revenue cycle management system

The process of managing the healthcare revenue cycle is a bit complex. So, we will have to dig in deeper with the details for better understanding:

Firstly, a patient makes an appointment to receive a medical service. Creating the patient’s profile, verifying his account, checking the insurance requirements, and scheduling the meeting with the doctor is all done by the administrative staff. Before registrations, there’s a pre-registration process in which the administrative staff member gets the patient’s insurance coverage plan and medical history to create his account.

Before a patient could undergo a certain medical procedure or receive a medical service, he will have to go through the authorization process. An approval from the insurance provider is necessary prior to the treatment procedure. If the authorization is not denied, the medical visit is completed and the medical claim is then created using all the protocols of the appropriate ICD-10 codes. The treatment procedures that a patient needs are identified and rendered using CPT codes.

Once the claim is created and submitted, the government or a private payer then receives a patient’s medical claim for reimbursement. It should be noted that the back-end processes like claim denials, financial processing, and cash handling are still needed to be dealt with.

After claim submission, the claim is evaluated closely by the payer.  The payer analyzes the patient’s medical coverage plan and payer contracts if any. Mistakes like improper or incomplete coding and missing account details will lead to delays or denials of claims. These denials need to be continuously followed-up on if the provider has any hope of receiving payment. Apart from the financial responsibilities stemming from the procedure included in the coverage plan, the patients must pay for other uncovered medical services that they have received.  Payers and patients that still owe payment must be continuously monitored; this entails Accounts Receivables, or simply, AR Management and is a crucial process for total revenue collections and appropriate cash flow handling.

The setbacks

Sometimes, the setbacks in running the revenue cycle can affect the whole back-end processes. However, there are a few ways to deal with setbacks.

Some Ways to tackle the setbacks

 

Innovative technologies and automated tools are developing rapidly in the Revenue Cycle Management industry, such as proprietary clean claim submission and analytics tools created by Avosina Medical Technologies, and it is imperative that physician practices and other healthcare organizations capitalize on harnessing these tools for optimizing their collections. 

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