Stages of the Revenue Cycle

Stages of the Revenue Cycle

Healthcare centers, clinics, and hospitals need to maintain a balance between remaining profitable and providing excellent care. One way to achieve this is through revenue cycle management, a process that streamlines the medical billing in your practice. It helps you bill insurance companies, submit claims, and conduct financial statements. Your medical practice may become more efficient by analyzing the cost of care and the patient’s financial situation.

Below are seven stages of effective revenue cycle management (RCM):

1. Patient Pre-Registration

Like any other business, patients should pre-register or check in when they arrive at your office. This can be done online using a patient portal or by filling out papers provided by the receptionist. At this stage, you collect patient information, such as name, insurance coverage, medical history, and billing information. This step allows you to set the financial tone at the start and avert payment questions.

2. Registration

The registration phase verifies the patient’s information, such as guarantors, date of birth, phone number, insurance information, and address. You will input the provider’s information and set up insurance coverage during this stage. It allows a transparent and accurate exchange of information about the patient.

3. Capturing and Entry of Fees and Services

Also known as charge capture, this is when you record information from patients’ services and send the claims to the insurance firms. You can do this in a couple of different ways. Your receptionist can manually enter information and send it. Or, by automation, you can use software to send billing information electronically to the insurance company. This phase allows you to modify your billing information, create a registration screen, and verify insurance eligibility.

4. Presenting Claim to Payer

Once you’ve entered the charges, you need to present the claim to the insurance company. Your revenue cycle team will look at the diagnosis code, CPT code, and charges at this step. They will review the codes to verify they’re correct and clean and that there are no duplicate claims.

They will send the claim to the patient’s insurance company and follow up to confirm whether or not it has been paid. This allows claims to be processed quickly. This step will enable you to query the insurance company to receive any necessary information or clarify issues.

5. Receive Payment

After the patient’s insurance company has analyzed and confirmed the claim, you’ll receive the patient’s medical bill from the payer. In this stage, your revenue cycle team will verify the amount owed and the patient’s financial status.

You can do a reconciliation to confirm that the patient is responsible for all charges and pay out the remainder using insurance claims. If you don’t receive full payment, you’ll need to process a delinquency claim with the patient. 

6. Insurance Follow-Up

You’ll need to make sure your patients’ claims get paid. The best way to do this is to follow up with the insurance companies after receiving their payment.

Follow-up clarifies that your patient has received the claims information so they can review it for accuracy. It keeps you informed about pending claims and finds out what happened if there is a problem. 

7. Process Review

You need to evaluate your RCM and find solutions without harming client care. By assessing your processes, you can achieve the best in patient reimbursement rates, client satisfaction, and the highest level of customer service. It helps you improve your claim denials and strengthen your collections. 

Get Help With Your Medical Billing

Revenue cycle management is a fundamental part of medical practice. It’s a transparent process that allows the exchange of information about the patient’s health status, insurance eligibility, and financial situation. It’s integral to medical billing regarding patient care and financial sustainability.