In this article, you will find all the steps in a healthcare institution's revenue cycle, information on healthcare regulations, and ways to optimize billing in your hospital.
Discover the path to efficient revenue cycle management in hospitals. Where to start? All the essential answers here.
The revenue cycle in a hospital involves several stages and is essential to ensure financial balance in a healthcare institution.
To achieve this, there must be good management of the cycle to increase revenue, correctly charge for services provided and avoid financial losses.
Revenue Cycle Stages
The revenue cycle of a hospital or clinic is made up of several stages, ranging from scheduling to post-care, as we will see below.
Appointment scheduling
The patient is scheduled and then registered in a database. For this step to work well, the data must be recorded accurately to avoid unnecessary errors such as duplicate records and typing issues.
Pre-registration and insurance verification
After collecting the patient's basic and insurance information, billing staff checks insurance eligibility to determine coverage and benefits.
Medical care and services
A patient goes to the hospital for a scheduled appointment. Upon entering the office, they may proceed with other procedures, such as taking a test or taking medication and requesting a follow-up appointment until discharge.
In customer service, it is possible to identify four stages of the cycle that generate revenue for the hospital, namely:
Patient admission;
Medical care;
Procedures;
High.
Documentation of services provided
The stages of the cycle described in the previous item, like everything in an institution, need to be documented and this combination is called a medical record. Based on this, a new process is initiated under the responsibility of the technical-administrative areas.
Procedure coding
Services provided by the medical billing agency professionals to patients are coded based on a standardized classification system, such as the International Classification of Diseases (ICD), to ensure that services are correctly identified for billing purposes.
Invoicing
With the previous information validated, hospital billing is responsible for generating the bill, which is standardized according to the operator.
The bill may vary depending on the regulations of the different agreements and factors such as types of contract.
Billing and claims
Bills are monitored based on their submission date and due date to ensure payment is received on the stipulated date. To this end, departments collect payments to avoid delays.
Accounts Receivable Management
At this stage, the company monitors the bills it expects to receive from customers. This includes recording issued invoices, monitoring bill payments and generating reports, as we will discuss below.
Financial reporting and analysis
Here, the approvals of the processes carried out in the previous stages are carried out, when the hospital billing team pulls the detailed documentation and with the necessary authorizations from the health insurance company.
There is an internal audit of the hospital in which the accounts are analyzed and the previous billing is checked . Once the accounts are validated, it is possible to carry out the external audit, contracted by the health insurance companies that perform the in-person checking of accounts.
Furthermore, the gloss recovery sector is active in order to recover lost revenue (amounts charged but not paid), and allows consultation of pricing tables, authorizations and medical records.
What are the best practices in data collection and documentation?
Data analysis is undoubtedly a necessary step in identifying patterns and trends that may be affecting the efficiency of the revenue cycle process.
Additionally, it is important to train all revenue cycle billing team members so that they are up to date on billing policies and practices, which helps prevent errors and ensure claims are submitted correctly.
Another essential practice is to adopt automated solutions that make the steps of the revenue cycle less manual.
Three are some solutions:
Automated hospital revenue management.
Automation of the medical bill glossing process.
Among other things, there is the guarantee of automated protocol records and the possibility of accounts being closed and validated automatically based on criticisms, auditing of accounts configured by operator or hospital and integration between accounts and the patient's electronic medical record.
Procedure Code Analysis and Billing
To perform code analysis and billing, it is so important to know the tables relating to both procedures, such as the Simpro table (which contains codes and prices of materials and medicines from partner laboratories, detailing the main procedures performed during hospital care) and the types of medical prescriptions and lists A, B and C that classify medicines by degree of control.
In addition, it is necessary to carry out a careful analysis to ensure that codes and billing are up to date, as well as to keep an eye on code tables and controlled medication lists, to avoid errors and increase the hospital's profitability.
Billing Rules and Regulations About Healthcare
Healthcare billing is influenced by strict rules and regulations to ensure compliance, accuracy, and transparency in the financial transactions between healthcare providers, patients, and insurance companies. These regulations include guidelines such as the Health Insurance Portability and Accountability Act (HIPAA) for patient privacy, the International Classification of Diseases (ICD) for coding, and payer-specific policies.
Billing must follow proper coding standards, adhere to documentation requirements, and avoid errors or fraudulent claims. By following these regulations, healthcare providers ensure smooth revenue cycle administration while minimizing claim rejections and delays in reimbursement.
Integrate Electronic Health Systems (EHR) with financial management software
Electronic health record (EHR) systems can send patient information in different formats to an electronic billing system.
Therefore, integrating systems with financial management software helps to improve hospital billing, as it automates processes, reduces human errors and speeds up revenue acquisition.
To make better use of these systems, it is necessary to understand which metrics need to be analyzed to increase hospital revenue.
The main ones include:
Accounts receivable period;
Payer performance;
Bad debts
Among others.
Conclusion
In this article, you saw the steps related to the hospital revenue cycle, best practices for data collection, procedure analysis, healthcare billing rules, and systems integration.
In addition, we present our solution, Revenue Cycle, which automates several processes such as the management of glosses, revenues and audits.
To start using our solution and see the difference in an adequate revenue cycle in your hospital, count and click here to schedule a conversation with our experts.
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