Healthcare revenue cycle is a financial process that guarantees complete reimbursements for a healthcare practice when carried out effectively. This process goes through a series of essential steps, each of which contributes to successful reimbursement of outstanding amount. The basic essentials of revenue cycle activities include:

• Payer Contracts
The physicians, healthcare organisations and practices set contract rates with their payers. The payers are the patients and insurance providers, who must ensure meeting the requirements of the contract after agreeing to its terms. The parties involved can negotiate, revise and pay the payment dues in a consistent and timely manner. Therefore, these payer contracts guarantee revenues for the healthcare provider.

• Appointment scheduling
Appointment setters schedule the specified time for the patient to meet their physician. This step is crucial to maintain patient flow in the healthcare revenue cycle process. Through appointment setting, the medical practice also creates an opportunity to collect patient data prior to their registration. Effective appointment scheduling prevents loss of revenue by implementing necessary strategies to handle missed and cancelled appointments.

• Registration
During pre-registration, a minimum amount of patient information is gathered. This information primarily includes demographic data, name, medical history etc. In the registration stage, additional information such as the patient’s insurance coverage details, exclusions, co-pays etc. are collected and reviewed. This is a crucial step, where patient data has to be accurate. Inaccuracies in patient information can lead to claim denials and even rake up the costs of healthcare revenue cycle.

• Medical Coding
Patient diagnosis and medical procedures are translated into alphanumeric medical codes by medical coders. This activity is important because claims are not settled in the absence of medical codes. The coding is carried out based on the medical coding classification systems such as ICD, CPT, HCPCS etc. Once the codes are fed into the electronic health records, the medical services are rendered into billable charges.

• Submitting Claims
The claims generated are reviewed and submitted directly or through practice management software. The claim would consist of medical codes, patient demographic information, site of service, insurance information etc. Sometimes, to ensure that the claims generated are error-free, the claims require to be thoroughly audited.

• A/R follow-up
Accounts receivable reports help keep track of the time taken for complete payments to be received from payers starting from the time of claim submission. This enables the medical practice to identify the average duration of time taken to get reimbursed. Denials cause the A/R days to prolong. Effective denial management enables the A/R days to be shortened.

• Medical Reporting
Medical documentation is necessary to analyse the healthcare revenue cycle as a whole. These comprehensive reports help keep track of the patient medical history, financial data, medical images etc. By carefully examining the medical reports, the medical practice can enhance their healthcare revenue cycle process.
Revenue cycle management consists of various sequential activities, that need to be carried out with great accuracy to maintain sound financial health of the medical practice. These basic activities contribute to improved revenues and profits for the health care provider.