Saturday, February 14, 2015

Healthcare Requires Cash: Revenue Cycle Management

No one expects to pay cash when they go to a hospital. After all, the usual reason for going is a medical emergency. Hospitals are typically paid by the patient’s health insurance. The problem is, this means that the facility will not receive payment until all the paperwork is done; which can throw a spoke in paying the bills for its maintenance. The functions and processes in capturing, managing, and collecting revenue in a healthcare system is known as revenue cycle.


Revenue cycle starts when a patient calls in for an appointment. Setting up an appointment means that the patient will have to give basic information about himself, including his name, phone number, and details on his insurance company. These are all that are needed to get the ball rolling. The next step should be to contact the incoming patient’s insurance company to confirm the patient’s coverage, before the scheduled appointment. Without this step, a patient who needs to be admitted might have to wait until the verification of his coverage, which could delay the administration of needed care

Verification before the appointment can help avoid problems that come with a claims denial later on. Many hospitals spend a lot on working to process denials—something which could be prevented with pre-verification. Monitoring the status of a claim in process can also help in avoiding a denial.

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