A revenue cycle is like a life cycle, to get to the next stage, you must complete the step prior. The first stage of the revenue cycle begins with the patient visit and ends when payments are received by the healthcare organization. This process might seem simple, but it is both complex and essential to both parties. As a healthcare organization it is vital you understand each stage of the revenue cycle because there lies the answer to optimization and profit.
This first stage is known as the bridge between scheduling admission to receive an appointment or service. However, that bridge contains a massive amount of information and can either start your revenue cycle off on the right or wrong foot. Information includes all demographic details such as patient name, address, date of birth and sometimes social security number. Once the demographic information is completed and verified, then there is collecting all the patient’s insurance. When insurance is collected and inputted there can then be a conversation regarding how much insurance covers, the deductible, or co-payment. If the pre-registration process is done right, provision of service should be crystal clear before they even set foot into your practice.
The patient registration step begins upon patient arrival. Each patient fills out a registration form on a variety of data regarding patient verification, health questions, and insurance information. This step might seem redundant to the first step but it’s of utmost importance because it confirms all information is correct and up to date. Not only that but if steps are skipped within this second stage your healthcare organization could be at risk of being audited or not receiving payment for services. This process protects both your organization and the patient because it provides documentation of patient service.
Capturing Charges and Converting it into a Billable Invoice
When you outsource to Credence Global Solutions, we take care of this step for you. We will automatically obtain charges from the visit and code the service that was rendered to the patient. After, we then convert all this information into a billable invoice and prepare the claim. One of the many benefits of letting us take care of this step is you won’t have to stress about coding errors or absent charges. Ultimately, when you outsource, we establish patient charges seamlessly so you can receive payment faster.
Submitting the Claim
The fourth stage of the revenue cycle also encompasses claim scrubbing. When you outsource the goal is to catch all errors before they are sent off to insurance. By having us claim scrub our job is to ensure claim denials are as non-existent as possible. Once all charges have been finally entered into the system, we then forward this to the insurance carrier.
This step is basically an explanation of the payments and is normally electronically posted. When it is posted it does need to be reviewed and processed. This step can consist of a variety of things you must analyze such as allowable, fee schedules, and write-offs. Which is why out of all the stages, remittance processing can be the most confusing and tedious. On the bright side, when you outsource you will never have to deal with this headache of a step.
Finally, after you have made it through all these stages it is time for your company to receive payment. Obtaining payment can be difficult but by consulting with Credence Global Solutions, it makes it much easier. With our intelligent healthcare patient engagement platform, iConnect, we know how to reach patients faster and collect payment in the quickest way possible. Reach out today and we can give you a look at how to facilitate your revenue cycle.