revenue cycle process

While providing high-quality patient care is the number one priority for all healthcare organizations, maintaining fiscal stability is another top concern. Not only does an effective revenue cycle management strategy keep the doors open of your healthcare facility and  goes hand in hand with patient satisfaction.

The need for an efficient revenue cycle management process was especially highlighted after the financial challenges of COVID-19. While the significant revenue and volume losses, and dwindling margins due to canceled elective procedures, shortage of ICU resources, and furloughs resulted in the closure of many healthcare practices ???, it also illustrated the importance of an optimized revenue management process everywhere else.

A healthcare revenue cycle process is a multi-faceted activity that is no longer just billing, coding, and collection. With many steps like pre-registration, registration, charge capture, utilization review, coding, claim submission, 3rd party follow-up, patient responsibility, remittance processing, and denial prevention, there is room for error at every step of the cycle. If a claim misses a pre-authorization or any other data, payment may be delayed due to claim denial and unbilled revenue for services rendered is the primary cause of hospital debt.

An exceptional revenue cycle process is a key to transforming that debt into recurring profit. The traditional approach of extensive interactions between payers, hospital staff, and insurance providers to manually extract data is time-consuming, and ineffective in this value-based care landscape, not to mention highly prone to costly errors. This is why you need to stop relying on historical methods and rethink your healthcare revenue strategies and develop innovative and efficient ones.

To improve the performance, productivity, and efficiency of your revenue cycle, the following strategies have proven to be effective in leading healthcare practices across the world.

  1. Automation of Workflow

A healthcare practice contains thousands of financial reports entering and leaving the system each day, each requiring thorough data analysis. However, doing this manually with outdated legacy software is not only time-consuming, but also increase the chances of human errors as it likely  for a human to miss something or misinterpret it. Highly repetitive tasks like eligibility verification, follow-up of claim status, creation of patient status, and determining which of the thousands of claims on standby deserve prompt attention can be easily automated to streamline workflow. Read More.