A healthcare revenue cycle is a process that involves workflow and organization. It effectively reduces costs, eliminates redundant work, and streamlines patient billing and prior authorizations.
Pre-Authorization
When a healthcare facility is working with a new patient, the administrators or clerical staff will gather the patient’s information and contact the insurance company to find out their coverage status. Once the team has verified the person’s copays and eligibility, they will either book an appointment or move to the next step.
Submission
The next phase of a healthcare revenue cycle involves submitting the claim. A medical biller will choose codes that highlight what the visit was about. The insurance company reads these figures and makes payments based upon the individual’s policy, the code, and other factors, such as the attending physician.
Rejections
Billing departments have to deal with rejected claims. The teams can resolve some issues in-house and resubmit the documents. There are times when the office can challenge the denial. In those cases, the staff will gather supporting facts and paperwork to support the claim.
Accounts Receivable
The final step will be rectifying all bills. Some patients may have to pay for all or part of their medical treatment. The accounting department may work out payment plans with them. A tracking system can monitor those accounts. If an insurance company and a patient do not pay, the healthcare facility is left with bad debt. The accounting team will likely hand the matter over to a collection agency. For tips on how to improve your office’s healthcare revenue cycle, contact AZZLY at Sitename.
