Great patient care is not the only thing in running a healthcare practice in the United States; it also needs a clean and well-managed revenue process. That is the place of Revenue Cycle Management (RCM).
In Acuity Health Solutions, the revenue cycle is a stepwise system that is clear. When all stages are going well, practices are paid more quickly as they cause less stress and remain economically fit. A basic, visual dissection of the 7 crucial processes in the revenue cycle that every practice is expected to be conversant with is as illustrated below.
7 Stages of Revenue Cycle
1. Scheduling
The Revenue Cycle begins even before the patient comes.
Having an appointment is not the same as planning. It is the initial chance to gather correct patient data, validate the nature of the visit and insurance information.
- Proper choice of providers and services.
- Proper patient demographics.
- Early insurance awareness
Clean scheduling eliminates delays and mistakes downstream.
2. Registration & Insurance Verification
Angel data upfront = reduced issues with billing in the future.
Patient information is verified and insurance checked during registration. This step will make services billable and minimize unexpected rejections.
- Check in cover and benefits.
- Make sure that there are copays and deductibles.
- Get relevant approvals.
This phase safeguards the practice and the patient.
3. Coding & Charge Capture
Commoditizing care.
Providers record care after the visit and coders turn the documentation into correct CPT and ICD-10 codes.
- Accurate medical coding
- Full patient chart records.
- Timely charge entry
Refrained or wrong codes translate to lost revenues.
4. Claim Submission
In the initial instance, a clean claim should be sent.
Forms are drafted and sent to the insurance payers. Errors-free claims are clean and they can be moved to payer systems with greater speed.
- Scrub claims for errors
- Send it electronically where possible.
- Meet payer-specific rules
Rapid payment is based on first-pass acceptance.
5. Payment Posting
Monitoring paid (and unpaid).
After the claims are received by the payers, payments and explanations of benefits (EOBs) are recorded on patient accounts.
- Match payments to charges
- Identify underpayments
- Assign patient responsibility.
Proper posting provides complete financial exposure.
6. Accounts Receivable (AR) Follow-Up.
Unpaid claims should not be left too long.
Not every claim pays on time. AR follow-up majors on the unresolved balances and old claims.
- Prioritize claims by age
- Contact payers for status
- Resubmit when necessary.
Follow-up ensures cash flow.
7. Denials Management
Cure the cause, and not the complaint.
conclusive;Rejections are not conclusive, they are feedback. The aim will be to be attractive where possible and avoid recurrence.
- Analyze denial trends
- Appeal valid claims
- Improve front-end processes
Effective denial management reinforces the whole revenue cycle.
Why Process Matters
Revenue cycle is best done as a system rather than disjointed activities. Each step affects the next.
Acuity Health Solutions assists the health care practices in the U.S. to remain orderly, disciplined, and financially robust by ensuring that every phase is handled in a clear and consistent manner.
With a well-stirred revenue cycle, your practice is free to concentrate on the most important things in life, taking care of patients.
