What Are The Steps In The Healthcare Revenue Cycle Management

The American medical industry is a for-profit-based business, for better or worse.

And for medical patients to get the most out of their paid for medical care, as well as for medical practices and insurers to profit, every step in the healthcare process must be followed meticulously.

And this is not just about the healthcare industry making healthy profits, even though it generated over $1.27 trillion in revenue in 2021. The healthcare industry is one that can benefit all involved in it.

The healthcare industry employs almost 15% of the American workforce in some capacity. About one-eighth of Americans are employed by the healthcare industry.

The healthcare industry comprises over 907,000 businesses and employs over 20 million Americans.

Almost 20% of the United State’s GDP was generated by the healthcare industry. The healthcare industry is the third largest one in the United States.

Healthcare is not cheap, and almost 32 million Americans don’t have health insurance. Still, the typical out-of-pocket cost annually for medical care is $5,000.

Over 82% of jobs offer employer-sponsored health insurance. And along with Medicaid and Medicare, qualifying Americans with no medical insurance can apply for federally-sponsored health care at Healthcare.gov.

The healthcare industry should be a well-oiled machine that does not always get the oil it needs. In other words, mistakes, erroneous paperwork, and miscommunications slow everything down for everyone.

So, what are the healthcare revenue cycle management system and its benefits?

Contact Rainbird Healthcare today to learn more about our A.I.-enabled claims processing algorithms.

Related: Top 10 Challenges In Medical Billing Today


What Is The Process Of Revenue Cycle Management?
Healthcare revenue cycle management is a bureaucratic strategy for enhancing, updating, and perfecting clinical and administrative functions throughout a full revenue cycle.

And the healthcare revenue cycle management system is more than just keeping track of a billing cycle. A revenue cycle includes tracking a healthcare cycle from the patient making an initial appointment to visit a doctor all the way to fully approved payment collections.

Revenue cycle management systems are transparent to all involved and help in the preemptive identification of flaws or errors in the cycle and rectify them before there are irrevocable issues.

What Are The 7 Steps Of Revenue Cycle Management?

A doctor with a clipboard looking off in the distance.

1. Preregistration
The preregistration process occurs during the appointment process or just before the patient shows up.

During preregistration, the medical provider will collect data from the patient like address, health insurance, deductible, coverage, co-pay, co-insurance, referral, and so on. The patient is also informed of their payment expectations, if applicable, payment deadline, and cancellation policy.

This initial information is passed on to the patient’s insurance company and circulated through the medical provider’s management system as well.

2. Registration
During the registration process, the medical provider will double-check if the patient’s vital data like name, date of birth, address, phone number, insurance data, guarantors, and affiliated data is corrected.

It’s vital for medical providers to inquire and verify that the patient has authorization or a referral to be treated. And if co-payment is due, the medical provider should collect it.

If there are mistakes during the registration process, then claims could be denied and payment forfeited later.

3. Charge Capture
Charge capture is the process of accounting for every applicable charge for medical services to be rendered to the patient.

During the charge capture process, the medical provider can automate or manually collect charging data, forward it to billing, and generate a file with an alphanumeric code for the patient’s file so this financial data can be correctly transmitted to the insurance company.

Every possible billing and ancillary charge must be considered during charge capture. Otherwise, revenue won’t be collected.

4. Claim Submission
After completing the charge capture process, a revenue cycle management team should double-check all the data collected before making a claim submission.

Revenue cycle management teams will “claim scrub” the alphanumeric coded patient now. They will double-check all of the code applications, diagnosis, services rendered, charges, and more to make sure the claim is free of mistakes.

If the claim is “clean,” the medical provider will get paid quicker. This is the final opportunity to catch any mistakes, small or large, that could jeopardize the claim being approved by the insurance company.

5. Remittance Processing
Remittance processing refers to the time period when the insurance carrier pays for the claim submission sent by the medical provider.

Medical providers should be reviewing their fee schedules and making sure every charge in the claim has been paid.

6. Insurance Follow-Up
During the insurance follow-up, the medical provider must check if they have been paid for all of their claims.

And it is also important to double-check if any claims have not been paid.

7. Patient Collections
Medical providers should get any payment from the patient when they are physically in the office.

But if that has not happened, now is the time to send billing notices on a 30-day cycle and then consider outsourcing to a collections agency if needed.

How Is Revenue Cycle Management Used In Health Care Organizations?

A doctor on the phone in her office.

The revenue cycle management system is used in health care organizations to check on the efficacy of the revenue cycle.

Mistakes, errors, and miscommunications must be checked, double-checked, and sometimes triple-checked from every stage of the revenue cycle, from the patient’s first appointment schedule to the final payment.

What Are The Benefits of Revenue Cycle Management?

The benefit of revenue cycle management teams is in finding errors, mistakes, or miscommunications in the revenue cycle, learning from them, and eradicating them from the system.

How Does Revenue Cycle Management Impact Health Information Management?

The greatest impact of the revenue cycle management system is that medical providers will find more of their claims being approved for insurance reimbursement.

Healthcare revenue cycle management systems exist for medical providers to find and improve upon errors in their revenue cycle, improve their processes, and increase the rate of claims approvals.

Trust Rainbird Healthcare to revolutionize your medical billing practices. Contact us today and learn how to increase your billing collections by 18% annually.

Related: What Exactly Is Healthcare Revenue Cycle Management

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