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Revenue Cycle Management

What is revenue cycle management?

Payer reimbursements, patient payments, monthly subscriptions, customized health packages, and other revenue sources must be managed efficiently for any healthcare to run successfully. Hence, Revenue Cycle Management plays a significant role in determining the success of healthcare organizations. It is paramount that the organization understand and execute an intelligent revenue cycle management.

What are the critical steps in revenue cycle management for healthcare organizations?

The critical steps in revenue cycle management for healthcare organizations are:

  • Pre-registration

Pre-registration is the first step in the revenue cycle management; this is where the organizations capture the patient’s health, financial, and insurance information. Like any other step in revenue cycle management, this is where technology could be leveraged to automate the entire process of verifying patients’ eligibility for payment and background checks.

  • Registration

Once the patient passes the verification, they will be registered in the organization’s system. At this point, the organization alerts the patient if any further information is required. This helps in avoiding unnecessary delays in payment.

  • Charge Entry and Capture

The organization records the various services the patient requires and shares the charges with the patient. This step is crucial in Revenue Cycle Management as here is where the organizations receive total compensation from the payers.

  • Claim Submission and Denial Management

Once the charge capture is done, it is time to move on to the ‘claim submission and denial management’. Here the organizations submit a coded claim to the payer. Again, this is where technology works its magic to ensure a seamless and error-free process. Using technology, organizations can submit clean claims and ensure fast payments.

If the claim is denied, the information capture process is invoked, and the payer is alerted to resubmit accurate details for the claim to be processed.

  • Payment

As the name suggests, this is the step where payments are processed – ideally, the reimbursement will be on the way, and the patient is asked to make the payment. In today’s world, this step is entirely digitalized in most organizations where the payers are requested to make payments through a patient portal – software will make ensure no slips with the completion of payments.

Here is a crucial step. The job is not done when the payments are through.  Healthcare organizations must use top-notch quality reporting technologies to avoid common mistakes and ensure the Revenue Cycle Management is running efficiently.

It is very imperative to clean up revenue cycle management for healthcare organizations to be on top of their game.

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