Revenue Cycle Management- HealthCare.

Healthcare revenue cycle management is the financial process facilities use to manage the administrative and clinical functions associates with the claims processing, payment and revenue generation.

The process consists of identifying, Managing and collecting patient service revenue.

The financial process is crucial to ensuring healthcare organizations stay in operation to treat patients. Facilities use healthcare revenue cycle management to collect profits and subsequently keep up with expenses.

The Basis of HealthCare Revenue Cycle Management.

Healthcare revenue cycle management begins when a patient makes an appointment to seek medical services.

the process end when organization have collected all claims and patient payments. 

From Hospitals Perspective:

 Pre-Registration:

1.    Employees create a patient account which includes the details of medical history and insurance coverages.

2.     Enters correct insurance details, Verify accurate demographics for the patients and collect the patients financial responsibilities at the front end all reduces rework through the revenue cycle and ultimately reduces the denials.

3.    after a patient visit is complete, the healthcare provide must create a claims submission and complete charge capture duties.

4.    the Provider or coder identifies the ICD-10 code that corresponds with the treatment, determining how much reimbursement the entity will receive from the patients health plan. Selecting the most appropriate code for services can help prevent claim denials.

5.    The charge capture process documents the services into billable fees.

6.    After a claim is created, the practice send the claim to the private or govt payer for reimbursement. but the RCM does not end there for healthcare systems. Organization still need to oversee back-end office tasks associates with claims reimbursement,(including payment posting, statement processing, payment collections and claim denials)

7.    once an Insurance company evaluates the claim, healthcare organizations typically receive reimbursement for the services  depending on the patients coverage and payer contracts.

In some cases claims can be denies for various reasons, such as improper coding, missing items in the patient chart, or incomplete patient accounts.

8.     for anything that insurance does not cove, healthcare organizations must notify and collect payments from the patient.

Healthcare RCM aims to develop a process that helps organizations receive payments  in full for the services as quickly as possible.

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