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The term “revenue cycle” is used to refer to the collective processes a healthcare facility must go through in order to organize all of their most important financial metrics.
The vital financial aspects that a healthcare organization needs to collect would be easy to lose track of if there weren’t an organized management system in pace to organize them, and that’s where the value of the revenue cycle truly shines.
The cycle, true to its name, is made up of a series of various revenue-relevant processes that all successively flow into one another. By establishing the cycle, healthcare facilities can ensure that they always have the right frame of perspective on their workflow and cash flow from operations.
Preparing the possibility of things going awry is a necessary evil in any kind of business model, but through the establishment of this cycle, it’s possible for a business to almost instantly catch wind of the first instance when something has fallen out of order.
Thanks to the organized pattern of operations that the cycle establishes, a discrepancy in the cycle immediately indicates that something isn’t as it should be – taking note of this as early as possible can minimize the chance that it compromises the business beyond the point of what’s recoverable from.
Specific Processes in the Customer Service Cycle
Different kinds of businesses will naturally establish different specific processes in their cycles, but generally speaking, the start of a healthcare organization’s cycle will be with patient scheduling or pre-registration.
Following the initial scheduling point of the cycle would come the point of collections. Collections are followed by case management, preceding the charge capture and submission claim. The final parts of the cycle involve following up with the third party, procession remittance/rejections, the final process of posting payment, appeals and collections.
In the initial pre-registration phase, every important aspect of registration is taken into account – this includes things such as authorizations and eligibility factors to be aware of before a patient’s procedures can legally begin.
During collections and charge capture, details regarding payment are arranged, balances are collected and documented services are transmitted into an invoice-ready bill form. Before the cycle is officially complete, parties such as insurers need to followed up with after claims have been filed so that collections can be acquired.
Following collections, the payments in question can be appropriately applied to whatever accounts they’re intended to be directed towards. With the final application of all scheduled collections, the cycle is official complete.
Organizational Security
By putting everything into an orderly process of operations, all parties can be assured that they are on the same page. By systematically organizing all of the important aspects of the cycle in the above manner, a facility can ensure that they’re able to stay on the right track in terms of remaining within management policy compliance at all times – for this reason, the revenue cycle is not only an organizational tool but also an important part of the business’s ability to stay afloat and out of legal trouble as well.