Key Components of a Healthcare Revenue Cycle

While it’s easy to associate your billing staff with revenue cycle management, many people forget that the revenue cycle actually begins with the first point of contact in your office.

Front Office

The right interactions by front office staff before treatment takes place will lead to more successful, fluid payment on the back end. A high level of customer service, can mean better online reviews or marks on a patient satisfaction survey. This can help increase your referrals and give you more leverage to negotiate rates with insurers.

Appropriate data collection is vital. You should verify eligibility and benefits prior to admission. You should also know co-pay and deductible rates and be prepared to collect from the patient prior to their arrival. Collecting co-pays at the time of care can help you avoid missing payments in the future, particularly since high-deductible plans are leaving patients responsible for a great portion of the bills than before. As a courtesy, you can inform the patient before to avoid any confusion once the patient is on-site.

Collecting all the information necessary to file claims can help you avoid unpaid or denied claims in the future. When a patient registers, front-end staff should collect:

• A copy of the insurance card

• A copy of the driver’s license

By empowering your front end staff to perform prior authorizations, eligibility checks, and co-pay collection, you decrease your risk for unpaid claims in the future.

Back-End

After the patient visit is complete, the back office takes over the revenue cycle, coding in the services rendered so they can be billed to insurance companies.

Claims management and timely follow-up is the most important process on the back-end. With a variety of different payors and claims requirements, claims management can be a complex and time-consuming process for staff. Staff must carefully check:

• Patient information accuracy

• Clinical documentation

• Appropriate codes and modifiers are included

No matter how diligent your billing team is, some claims will inevitably be denied. If you are understaffed or do not have a billing team dedicated to follow-up, it can be challenging to keep consistent cash flow.

Your team should have consistent daily processes to address aging unpaid claims, including a task reminder for follow-up and thorough recordkeeping processes. It’s important not to neglect old or difficult claims while still submitting current documentation requests or appeals in a timely manner.

Occasionally, balances will need to be written off if they cannot be collected. Your management and billing team should have a monthly meeting to discuss problem claims, outstanding appeals and if any money will not be collected.

Money collection is what allows you to serve your patients. At Datapro, we help you through all stages of the revenue cycle so you can focus on what you do best.

Let us help you! Contact us at 805-579-3537 or fill out our online form to learn more about our services