The seven-step healthcare revenue cycle explained

  • Written by Yash Rajan
  • Monday 5th September 2022
The seven-step healthcare revenue cycle explained VLMS Healthcare

The healthcare revenue cycle is a method that healthcare organizations implement to monitor patient billing from the time of the initial visit until the patient pays the charges. The revenue cycle in the healthcare industry is a difficult process with many obstacles. The cycle is made to deal with the complexity of medical billing cycles while still enabling healthcare facilities to offer the best possible treatment to patients. This blog discusses each procedure in detail, including what it entails, potential problems that might arise along the revenue cycle, and how to prevent mistakes.

  1. Pre-registration

    The first and most important phase of the healthcare revenue cycle is pre registration. Oftentimes at the appointment booking stage, pre registration enables a healthcare practitioner to rapidly collect demographic data, insurance details, and eligibility information through a medical insurance claim clearinghouse.

    The patient's insurance company receives the information before it is delivered through the case management system of the doctor. After which the patient's coverage, premiums, co-payment, co-insurance, and, in some cases, whether the patient needs a referral, are reported to the insurer.
    The pre-registration phase eliminates any future payment-related concerns and enables a healthcare practitioner to get the funds in order right now. If a service lacks a strict pre registration procedure, many mistakes may be overlooked. To guarantee a smooth beginning to the billing process, review the preregistration protocol.

  2. Registration

    The confidentiality and authenticity of a patient's details are guaranteed by registration. At this point, the provider confirms the patient's identity credentials, including contact and insurance information. Every time this data is accessed, providers are required to protect it.

    The medical institution now collects co-payments, and if special care is to be provided, the receiving physician makes sure that a referral authorization is in place.
    Bypassing the authorisation of referral will result in a denial of payment for the services provided. Insurance payouts are then distributed when financial documents have been signed. If these steps are omitted, an audit is likely to have negative financial effects.

  3. Capture charge

    The third step of the health revenue cycle, charge capture, can be carried out in a number of ways. In order to automatically input data from their papers into the case management billing system, healthcare providers can automate the procedure. The option is to carry out the procedure in a conventional manner, by manually entering the data or sending it to billing.

    Both systems have advantages and disadvantages since it is possible to forget to pay for costs like supplementary services in both scenarios, which results in lost income. To prevent missing costs, make sure you are properly coding fees and communicating them to the health insurance.

  4. Submission of Claims

    After documenting charges, this phase entails sending information to the insurance company. All diagnostic codes will be examined by the revenue cycle team to assess their uniformity and correctness. They will ask if the suggested diagnosis supports the chosen course of action. If several services are provided, they must be distinguished from one another and correctly coded.

  5. Remittance processing

    The fifth phase in the cycle is the processing of remittances. A health provider will collect their remittances after relaying their claims to the insurance. The contract is negotiated between the hospital and the insurance provider, and the insurance company then determines the amount of each item's payment.

  6. Insurance follow up

    The sixth phase of the revenue cycle, insurance follow-up, makes sure this is fixed. Health care providers look at both payments and non-payments. What happens to the supplies the vendor didn't get paid for? All of the items with lengthy payment delays are shown in the accounts receivable report. This study will show whether or not the provider is having trouble following up with insurance companies, as well as why it is taking so long to be paid. The supplier can then make any required corrections.

  7. Patient collection

    Patient balances and entitlements are calculated in this last phase of the healthcare revenue cycle, producing a statement. The balances of the payments made by different patients are kept, and outstanding accounts are constantly checked. Make sure to have a consistent procedure for collecting deductibles and copayments in order to prevent stacking up the patient collections. The policy should fully describe the financial goals of your organization.

If you are having trouble controlling the healthcare revenue cycle, connect with one of our experts to have your practices reviewed. Fixing up the revenue processes now will pay off in the future with VLMS Global Healthcare..