Revenue Cycle Management

Revenue cycle management is a crucial component of any healthcare provider’s business. When the revenue cycle is operating smoothly, the effects can be felt in nearly every aspect of your practice. On the flip side, a practice’s struggles with the revenue cycle can lead to confused patients, frustrated staff, and a loss of revenue. Understanding each component of revenue cycle management is the first step toward creating a system that will improve outcomes positively for your practice.

What is Revenue Cycle Management?

Revenue cycle management is the financial process your practice uses to track your patients from the moment they make an appointment to the time they make their final payment. The entire revenue cycle involves several stages and each one is important in order to maximize revenue.

After a patient visits your practice and receives services from his or her healthcare provider, the claims submission process begins. Using medical coding, billable fees are submitted to the health insurance company so that it can determine how much of the bill the company is responsible for paying. Insurance companies review the claim for accuracy and legitimacy, taking a variety of factors into consideration as they process the claim. Once the claim has been fully assessed, the insurance company will either accept or deny the claim.

While most insurance companies have up to 30 days to either approve or reject a claim, it is considered an industry best practice to follow up on the status of a claim within seven to 10 days after it was submitted. Initiating follow up with the insurance company is one of the best ways to ensure your practice receives payment in a timely manner.

When contacting the insurance representatives, your medical staff should try to find out as many details about the status of the claim as possible, including if any additional information is required to make a decision on payment.

If the insurance company decides to pay for the entirety or a portion of the medical bill, a payment and explanation of benefits will be sent to the practice. The payments from the insurance company and any payments from the patient are then posted into your billing system. Paying close attention to detail during this step is extremely important if you hope to capture an accurate picture of a patient’s account and the practice’s finances. Once this phase is completed, the revenue cycle has come to an end.

Swift and effective denial management becomes important in cases when the insurance company denies your claim. In many cases, claims are denied due to medical coding errors, missing information, or simple administrative mistakes. Having a sound revenue cycle management process from the beginning will help reduce the number of denials due to simple and preventable errors. Once the reason for denial is determined, an appeal should quickly be filed so that the process does not continue to be delayed. Many healthcare practices lose money because denied claims were never re-submitted or were submitted after the deadline had passed.

Why is Revenue Cycle Management Important?

The main goal of implementing an effective revenue cycle management system is to reduce the time between providing services and receiving payment. Improving revenue cycles in healthcare is a crucial part of maintaining the success of any practice. Healthcare providers are losing money due to denied claims and increased time between initial service and final payment. As many practices take on more patients and move to different healthcare models, outdated methods of managing patient information and billing processes are holding practices back from true growth.

While the revenue cycle is complex, understanding how to best manage it can make a profound difference in the progress of your practice. Properly managing your revenue cycle will reduce time-consuming and costly errors, prevent delays in payment, decrease insurance claim denials, and increase your overall revenue.

There are some key problems that many practices and health care providers encounter in their revenue cycle management. These issues can cause a practice to struggle with patient billing and see an increase in claim denials. Simply put, some medical staff has not been properly trained on the industry best practices related to revenue cycle management. In other cases, a staff might not realize how its work directly impacts the revenue cycle. It is crucial that all staff members are on the same page when it comes to revenue cycle management. It is also imperative that everyone in the practice has been educated on the processes and procedures put in place to maximize the revenue cycle.

Because revenue cycle management must involve several people in order to be successful, good communication among staff members becomes increasingly important. Physicians, medical coders, office managers, and administrative staff should be in constant contact with each other on issues related to accounting, collections, and revenue. When busy schedules or competing priorities prevent clear communication, problems in revenue cycle management can quickly arise.

The revenue cycle is a process with many steps. Making an error at the beginning of the process can be detrimental further down the line, while missing a step altogether can lead to a loss of revenue. Effectively managing your revenue cycle means establishing a productive workflow that all staff members understand and follow. When everyone takes ownership of revenue cycle management from beginning to end, your practice will become more financially secure.

What QueueLogix Can Do for You

Does managing the twists and turns of the revenue cycle seem daunting? Is your practice looking for a way to streamline your existing processes? Whatever your individual need, QueueLogix has a solution that is completely customizable. Your staff already works hard to deliver the best care for patients, so we believe that healthcare technology should be an asset, not a burden. Using innovation and efficiency, QueueLogix’s software and services are specifically designed to optimize your revenue cycle and help your practice thrive without compromising the patient experience. Contact us today to find out which of our services are right for you.