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revenue cycle management - E-Learning System

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SUMMARY CHAPTER 6

REVENUE CYCLE MANAGEMENT OBJECTIVES What is revenue cycle management (RCM)? Key players in revenue cycle management (RCM) Stages in revenue cycle management (RCM) Revenue Cycle Process Revenue Cycle Management System SUMMARY What is revenue cycle management (RCM)? Profit = Revenue - Cost Revenue Cycle Management (RCM) in healthcare is the process of managing claims process, payment, and revenue generation. Key players in revenue cycle management (RCM) Four key players in the Revenue Cycle Management (RCM) of healthcare system are, 1) 2) 3) 4)

Patient Healthcare provider Billing company Insurance payer

REVENUE CYCLE MANAGEMENT IN HEALTHCARE

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SUMMARY CHAPTER 6

REVENUE CYCLE MANAGEMENT Stages in revenue cycle management (RCM) Revenue cycle consists of the following three stages, 1) Preservice Stage. It consists of all the activities prior to the patient’s encounter with the healthcare provider. 2) Service Stage. It is the actual point where the patient receives the service from the healthcare provider. 3) Postservice Stage. Activities subsequent to the delivery of care to the patient fall under this stage. Revenue Cycle Process The revenue cycle process involves the following ten steps: 1) Patient Verification & Scheduling 2)

Patient and Provider Encounter

3)

Medical Transcription

4)

Charge Entry

5)

Medical Coding

6)

Claim Submission

7)

Payment Posting

8)

Accounts Receivable

9)

Write off, Refund, & Collections

REVENUE CYCLE MANAGEMENT IN HEALTHCARE

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SUMMARY CHAPTER 6

REVENUE CYCLE MANAGEMENT 10) Closing of Account Revenue Cycle Management System Typically an ideal revenue cycle management solution should possess the following basic features, 1) Real-time data: Should be able to generate realtime eligibility, real-time report generation, and real-time clinical information. 2)

Ability to integrate and upgrade: Should offer a great level of flexibility and scalability.

3)

Security: Should have a robust and comprehensive security feature.

4)

Hybrid (Professional and Institutional): Should be able to handle both the professional-side and the institutional-side billing.

5)

Patient Focused: Should be designed in a way to encourage patient involvement.

6)

Mobility: Should be able to be accessed at anytime and from anywhere.

REVENUE CYCLE MANAGEMENT IN HEALTHCARE

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revenue cycle management - E-Learning System

SUMMARY CHAPTER 6 REVENUE CYCLE MANAGEMENT OBJECTIVES What is revenue cycle management (RCM)? Key players in revenue cycle management (RCM) Stages in...

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