The revenue cycle of the healthcare system starts when the patient reaches the hospital for scheduling an appointment and it ends when all the bills and payments for the appointments are collected from him.
The healthcare revenue cycle is useful as it is necessary to identify all the pain points in the process and to resolve them. When there is proper revenue cycle management in healthcare, it will be possible for the hospital to reimburse and increase their basic revenue.
Steps involved in the revenue cycle:
The healthcare revenue cycle will have many steps to follow making it possible to get many errors as well in the process. Any possible error will delay the process and halt the reimbursement altogether.
The below are the steps that have to be followed for better health care management and to eradicate any possible errors.
● Eligibility Verification
When the patient is admitted, along with the basic information, the health care provider has to collect all the details pertaining to the patient’s insurance.
Later they have to verify if the patient is truly eligible for the said insurance.
● Charge Capturing
This is the process in which the services offered to the patients are transcribed into codes that are accepted anywhere in the universe. The insurance company will accept the insurance claim with the help of these medical codes.
● Submit the claims
These codes will be sent for approval from the insurance company.
● Payment collection
As soon as the claim for insurance from the patient is accepted, depending on the insurance eligibility, the insurance company will reimburse the provider.
● Medical Service Review
When the complete process is done, as everything will be recorded, it will be available to analyze treatment data. In any of the steps, if there is an error, the health care provider will change and increase revenue as well as patient experience.
● Denial Management
This is the major step in which the payments will be either accepted or rejected after claims have been received. When the claims are rejected it should be crucial how they deal with the delay in the payment.
● Insurance Follow Up
The accounts receivable report shows all the details related to the insurance. It is always good to follow up on the insurance and see why it is taking time to get paid.
How to avoid Health care Fraud
Patients will sometimes do fraud while claiming insurance. In order to get saved from that, it is better to learn the types of frauds patients will do.
- Patients sometimes provide inaccurate details about their insurance coverage. Some might even claim insurance for which they are not even qualified.
- The main type of fraud nowadays is medical identity theft. In this, the providers as well as the victims have to pay for the insurance.
The healthcare revenue cycle is the process in which the patient is identified, managed and all his claims will be reimbursed after following the specific procedure.
All hospitals mostly follow the same procedure for maintaining their health care revenue cycle.
