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More than Codes: The Revenue Cycle

By:   |   Jul 08, 2018   |   Views: 10   |   Comments: 0

The revenue cycle is an integral part of the operations within a healthcare facility. After physicians have documented a patient visit, they need to be reimbursed for the services offers. Reimbursement for these services can be paid from a patient or through the patient's health insurance provider. However, effective revenue cycle management is more than just receiving payment for services. The revenue cycle for a medical practice includes multiple functions that must be performed at optimal levels by all parties involved including physicians, managers, and staff. The revenue cycle begins with front office staff. In order to effectively begin the process, front office staff must accurately capture demographic information and verify insurance eligibility. Without this information, the process can never begin and will only delay payment for the services. Information captured improperly only creates more frustration towards the end of the process when it is time to fix the problem. When using an EMR system that includes a Revenue Cycle Management portion eliminates many of these pitfalls through proper workflow and alerts. After this information has been captured, physicians can then properly administer services and staff can begin the charge and coding process. Coding is often the challenging part for medical practices. Typically, a biller or service provider will have to accurately document the CPT, ICD-9, and Modifiers to reduce the potential for rejected claims from insurance payors. Again, using an EMR system in conjunction with a service provider that includes these functions offer features such as "claim scrubbing" - alerting users when coding has been incorrectly. After coding has been completed, these same claims can be prepared for submission. The time between submitting claims and receiving payment is critical to cashflow for a medical practice. Claims with errors result in a longer cycle and puts a strain on the cashflow within a medical practice. With the growth of technology in every industry, many insurance companies encourage the electronic submission of claims. Billing handled through an integrated EMR system enables this entire process to be handled electronically. Additionally, claims submitted electronically are typically reimbursed faster. Effectively performing these tasks within an EMR system allows practices to grow to new levels and gain better efficiency.

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