HEALTH

Healthcare Revenue Cycle Management and the Patient Journey 

What is Healthcare Revenue Cycle Management?Revenue cycle management (RCM) is the process that healthcare organizations use to track patient care episodes from start to finish and ensure that reimbursement is received for the services provided.

The revenue cycle begins when a patient schedules an appointment and ends when the patient pays their bill or the insurance company pays the provider. Each encounter with a patient has the potential to generate revenue for the provider. To ensure that all revenue is captured, providers must have a well-designed and implemented RCM system in place.

There are three primary elements to RCM:

1) patient registration

2) billing and collections

3) and claims management

Patient Registration 

Patient registration is the process of creating a patient record in the provider’s system and 

collecting demographic and insurance information. This information is used to generate a patient’s medical record, which is used by the provider to document the care that is given to the patient.

Billing and Collections

Billing and collections is the process of submitting claims to insurance companies and patient’s for reimbursement for the care that was provided. This process can be complex, as there are many different types of insurance plans with different reimbursement rates. In addition, patient’s often have deductible’s and co-insurance’s that must be collected before the provider receives reimbursement.

Claims Management 

Claims management is the process of ensuring that claims are paid by the insurance companies in a timely manner. This can be a complex process, as insurance companies often have different payment cycles and may require additional information before they will process a claim.

The Patient Journey and RCM Systems 

About Healthcare Revenue Cycle Management Services, to be successful, RCM systems must be designed with an understanding of the Patient Journey. The Patient Journey is the path that a patient takes from the time they schedule an appointment until the time they pay their bill. By understanding the Patient Journey, providers can design their RCM system to optimize the revenue cycle and improve patient satisfaction.

There are four steps in the Patient Journey:

1) Patient Schedules Appointment,

2) Patient Receives Care,

3) Patient is Billed,

4) Patient Pays Bill.

By understanding each step in the Patient Journey, providers can design their Atlantic RCM system to optimize the revenue cycle and improve patient satisfaction.

Patient Schedules Appointment:

The first step in the Patient Journey is when the patient schedules an appointment. This is the start of the revenue cycle, as the provider will generate revenue from the care that they provide to the patient.

Patient Registrars play a critical role in the revenue cycle, as they are responsible for collecting patient demographic and insurance information. This information is used to generate the patient’s medical record, which is used by the provider to document the care that is given to the patient.

It is important for patient registrars to collect accurate and up-to-date information, as this will impact the provider’s ability to generate revenue.

Patient Receives Care:

The second step in the Patient Journey is when the patient receives care. This is the point at which the provider generates revenue from the care that they provide to the patient.

Providers document the care that they provide to patients in the patient’s medical record. This documentation is used to generate the patient’s bill. It is important for providers to document the care that they provide in a detailed and accurate manner, as this will impact the provider’s ability to generate revenue.

Patient is Billed:

The third step in the Patient Journey is when the patient is billed. This is the point at which the provider submits a claim to the insurance company for reimbursement.

Billing and collections is a complex process, as there are many different types of insurance plans with different reimbursement rates. In addition, patient’s often have deductible’s and co-insurance’s that must be collected before the provider receives reimbursement.

It is important for providers to submit accurate and timely claims, as this will impact the provider’s ability to generate revenue.

Patient Pays Bill:

The fourth and final step in the Patient Journey is when the patient pays their bill. This is the end of the revenue cycle, as the provider has received reimbursement for the care that they provided to the patient.

Once the patient has paid their bill, the provider’s RCM system is complete. It is important for providers to have a well-designed and implemented RCM system in place, as this will ensure that all revenue is captured and the provider is paid for the care that they provide.