Revenue Cycle In Healthcare

-Maintaining accounts receivable aging reports and constantly review and resolve past due, credit, and debit

The basis of the revenue cycle in Epic is the Hospital Account Record, often abbreviated as the HAR.

It is essential for an administrator to understand how private and government payers impact actual reimbursement. Government payers have a standardized benefit structure. The one benefit is that registration staff have an easier time calculating payment due (copayments) for service and can set up payment arrangements. Since the most significant proportion of funds coming into a healthcare organization is usually payments from third-party payers, therefore, it is critical to know how each reimbursement affect the others that come in. Healthcare organization may have hundreds of different payer’s relationships in the form of different contracts that have their own rates of payment that are usually different from other payers for an identical

The revenue cycle represent the flow of cash from the beginning to end and source. For any business large or small, public or private the revenue cycle is critical. In a hospital setting the revenue cycle begins at the time the patient first presents for treatment and is registered as a patient. This is “depicted within the text in Figure 2-1 as six stages- provide services, document services, establish charge, prepare claim/bill, submit claim and receive payment” (Cleverley, Cleverley, & Song, 2012, p. 14). Accuracy of information entered is paramount because the record created starts is the foundation for all future billing. If the wrong insurance information is documented time is lost on the back end of the cycle contacting the patient to update their

Accelerating cash collections at the point of service has never been more critical than it is today. Sophisticated accounting tools that enable providers to analyze patient utilization and outcomes help practice managers monitor payer performance and evaluate external contracts effectively. Growing financial pressure to strive toward more efficient claims flow through the revenue cycle means every provider must search for innovative tools to overcome the challenges.

Patient Accounting and Practice Management systems are designed to help health care medical practices are to improve the quality of care, cut cost, reduce risk, and increase revenues. When it comes to the size of a medical practice from small, or to a large medical practice, multi-location group this will feather the system to allow in creating and maintaining a patient billing information much faster and more efficiently then it was ever before. Medical Assistants are able to enter a patient information and post any changes much faster and more accurately with the use of a simplified medical billing software that promotes physician acceptance and much greater investment protection that provides faster insurance reimbursement and to improve

Souza, M. & McCarty, B. (2007). From bottom to top: How one provider retooled its collections [electronic version]. Healthcare Financial Management, 61(9), 67-73.

Revenue determination is an important tool for health care organizations because it allows for efficient management of payment systems. This paper will look at the different components that form the payment-determination bases of revenue determination. Moreover, the difference between specific and bundled service payments will be discussed. Lastly, the three ways health care providers control their revenue function will be highlighted.

Revenue cycle management (RCM) has become increasingly complex thanks in large part to the almost-constant health care reforms and initiatives. As ICD-10 is about to become the new coding standard, hospitals and private practices have begun arming themselves with as many tools and techniques as they can that will help them better manage their revenue cycles.

In the medical billing revenue cycle, there are ten steps. The first step is patient preregistration where a patient schedules a visit and their insurance is either verified or on file. The second step is to determine the patient’s payment when visiting the provider and the reason for their visit. Next is to check the patient in upon arrival at their visit. This is to verify the insurance and the identity of the patient. The patient is checked out after seeing the provider and charges for services will show on the superbill. After this, the medical biller takes the patient’s superbill and creates a claim. From here, the biller must ensure that the claim is compliant with coding and arrangement. From here, the claim is prepared and finally

In order to insure each staff member was obtaining their individual and team goals, each member was given their own business (Souza). The tools in which the PFS were given provided them with the tools to prioritize and automate account work lists, sort accounts in various ways and see at a glance their ranking with their work group and office-wide. Managers were given their own dashboard and tools which able them to use query all aspects of receivables for trending purposes and identify problem areas, drill down to the patient account level, monitor revenue, payments, adjustments, receivables, and days for periods from the previous day and week to the previous 18 months, calculate average daily revenue by day and 30-day period, assess their performance for the month to date, and estimate likely results at the month end, view all receivables or select any segment for quick analysis, and generate timely reports on demand, including aging analysis, A/R stratification, discharged not final billed (DNFB) analysis, credit balance analysis, and analysis of problem payers. Finally, a denials management component was implemented in late summer, which will allow registration staff to go online at the end of the year (Souza).

Accounts receivable are amounts owed by customers on account. They result from the sale of goods and services on credit. These receivables are generally expected to be collected within 30 to 60 days. They are typically the most significant type of claim held by a company. Accounts receivable and notes receivable resulting from sales are also known as trade receivables. Accounts receivable resulting from sales are referred to as trade receivables in Alcatel's financial statements.

He provided insight into the development of Cerner Revenue Cycle and their vision as they continue to advance the revenue cycle solutions.

11. Accounts receivable turnover and days sales in accounts receivable for the last three years:

Account Payable – records information about money that organization owes to suppliers and service providers