Healthcare revenue cycle management begins when a patient makes an appointment to seek medical services. The process ends when organizations have collected all claims and patient payments. However, the life of a patient’s account is not as straightforward as it seems. To start, when a patient arranges an appointment, administrative staff must handle the scheduling, insurance eligibility verification, and patient account establishment. Pre-registration is key to optimizing revenue cycle management processes. Employees create a patient account that details medical histories and insurance coverages during this step. The provider or coder identifies the ICD-10 code that corresponds with the treatment, determining how much reimbursement the entity will receive from the patient’s health plan. Selecting the most appropriate code for services can help prevent claim denials. The charge capture process documents the services into billable fees.
After a claim is created, the practice sends the claim to the private or government payer for reimbursement. But the revenue cycle management does not end there for healthcare systems. Organizations still need to oversee back-end office tasks associated with claims reimbursements, including payment posting, statement processing, payment collections, and claim denials. Once an insurance company evaluates the claim, healthcare organizations typically receive reimbursement for their services, depending on the patient’s coverage and payer contracts. In some cases, claims can be denied for various reasons, such as improper coding, missing items in the patient chart, or incomplete patient accounts.
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