How Clinicians Master Healthcare Revenue Cycle Management Mechanics

Physicians track revenue and handle patient care based on the seven steps of the healthcare revenue cycle. Practice management dictates adherence to this system as it ensures payment at the end of services. It’s a common misconception that the revenue cycle for medical practices begins when the patient sets the appointment. Clinical pre-arrangement determines the quality of patient care, which ultimately leads to revenue.

Before the pre-registration stage and long before the insurance follow-up stage, clinics should have a checklist or record closely tracking what costs are reimbursed and what costs will fall on the patient. Accounts receivable (A/R) reports can be revealing – but, the following factors should determine the structure of the healthcare revenue cycle:

  • Medicaid/Medicare Billing Solutions
  • Billing Cross-training
  • Claim Appeal and Resubmission

Revenue cycle processes are based on the insurance follow-up stage. A structural consultant advises internal clinical teams on the ins and outs of practice collections.

The Seven Steps of the Revenue Cycle

It all simply begins and ends with patient care. The visit initiates the cycle and ends with patient discharge. According to the agreed-upon methodology, the seven steps are as follows:

  1. Preregistration
  2. Registration
  3. Charge Capture
  4. Claim Submission
  5. Remittance Processing
  6. Insurance Follow-up
  7. Patient Collections

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