The revenue cycle includes all the administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue, according to the Healthcare Financial Management Association (HFMA).
Here is what’s involved in the revenue cycle:
- Charge capture: Rendering medical services to billable charges.
- Claim submission: Submitting claims of billable fees to insurance companies.
- Coding: Properly coding diagnoses and procedures.
- Patient collections: Determining patient balances and collecting payments.
- Preregistration: Collecting preregistration information, such as insurance coverage, before a patient arrives for inpatient or outpatient procedures.
- Registration: Collecting subsequent patient information during registration to establish a medical record number and meet various regulatory, financial and clinical requirements.
- Remittance processing: Applying or rejecting payments through remittance processing.
- Third-party follow up: Collecting payments from third-party insurers.
- Utilization review: Examining the necessity of medical services.
Factors that affect the revenue cycle:
As with any financial matters, there are internal and external factors that affect how revenue is collected.