Managing your contracts and revenue cycles is easy – if you know what to do. But, there’s a good chance that you are reading this because you want to get a clearer understanding of not just how to manage your contracts and revenue cycles, but also how to do so successfully.
This article details all you need to know and do to successfully manage your contracts and revenue cycles.
What is Revenue Cycle Management?
Revenue cycle management simply refers to the process used by healthcare systems to track revenue from patients from their initial appointment to their payment of balance. A typical revenue cycle starts with the first appointment of a patient and ends when the medical service provider gets fully paid for it’s services.
The Steps Of Revenue Cycle
To successfully manage your revenue cycle, you need to identify and understand the various steps of revenue cycle:
Step #1: Pre Registration Process
Apart from being the first step, this is also, perhaps, the most important step in the revenue cycle process. During the pre registration stage, medical service providers can easily collect data about their patients even over the phone. This information could include eligibility, insurance information and demographic information. The collected data is then sent to the patient’s insurance provider who will indicate the patient’s co-payment, coverage, and deductible.
Step #2: Registration Process
The registration process simply helps confirm the collected patient’s data. During this process, it is essential to double-check and confirm that all details provided by patient’s are correct. Even the minutest error in documenting a phone number or home address can eventually ruin your revenue cycle. So, ensure that you have the right address, phone number, date of birth, insurance information, guarantor’s details and so on.
You should also ensure that the necessary financial forms are signed during this process. No doubt, the registration process requires a lot of time and attention to details, so if you are not careful, it can become all too easy to miss important details. This is why most practices choose to work with medical contracting companies as this helps them save time and ensure that the registration process is properly handled. If the right steps are missed during the registration process, it could lead to financial issues down the road, especially if the practice is audited.
Step #3: Charge Capture
There are different ways to handle charge capture. Your practice can decide to automate this process, in this case the collected data automatically goes into the practice management billing side based on information given by the provider in their documentation. However, if your practice decides to handle this process manually, a desk staff will have to manually send this information to billing.
Of course, while it may seem like automating this process is a much better option, both approaches come with advantages and disadvantages. So, it’s always best to seek an expert’s opinion before choosing a method.
Step #4: Claim Submission
This process includes sending information to the insurance provider after the charges have been documented. During this stage, the revenue cycle team will examine the charges, the CPT code, and the diagnosis code. The team will also determine if the diagnosis can support the procedure performed.
The team may also decide to perform claim scrubbing – which is the process of ensuring that claims are clean and correct. A clean claim gets paid a lot faster. At this stage, the practice should also critically review the transmission report to quickly spot and fix errors if there are any.
Step #5: Remittance Processing
Once the claims have been sent, you will receive remittances. During this process, the allowable are determined. These are all the things the provider has contractually agreed on with the insurance carrier on a service or services provided.
It is important to critically review the remittances to ensure that there are no errors. One of the many important things to consider during this process are fee schedules – these are the amounts charged by providers for the services rendered. You should review and confirm that the fee schedules are correct and align with the contracts and allowables.
The last phase of the remittance process includes write-offs. Write-offs can be both contractual and non-contractual. There are multiple factors to consider before choosing the type of write-offs to work with. So, it is often best to speak with a professional before making a choice.
Step #6: Insurance Follow-Up
At this stage, you should examine what has been paid and what has not been. You should work with an accounts receivable (A/R) report, as this will asilu show everything you need to know at a glance.
One of the most important elements of insurance follow-up is asking the right questions. For instance, you need to know if your billing team is cross trained, if your practice management team is working with the insurance, and so on.
If you can properly carry out each step of the revenue cycle, you’ll find that managing your contracts and revenue cycle isn’t as hard as you thought. You should consult an expert if you are struggling with any aspect of your revenue cycle.