![]() Claims may be resubmitted for payment and patients need to be contacted to make payments on an outstanding balance. The back end of the healthcare revenue cycle flowchart includes things such as checking the status of claims, patient statements and analyzing claim denials. Regulatory compliance is also crucial in the transactional section of the flowchart. A mistake in this section of the revenue cycle can cost the organization dearly, resulting in slow payments or the denial of claims. It is the largest and most crucial part of the healthcare revenue cycle flowchart. This is where charges are entered into the system, claims are submitted, and payments are posted for services rendered. This also includes posting payments, claim scrubbing and EFT processing, among other things. The transactional section of the healthcare revenue cycle flowchart includes everything from charge entry to cash reconciliation. A best practices revenue cycle process also includes payment arrangements for any outstanding balance that may not be covered by insurance. Co-pays and deductibles are also collected at this point. This is where a patient’s contact information is documented, and current insurance coverage is verified. This part of the process is crucial to the rest of the healthcare revenue cycle. It includes everything from patient registration to deductibles, coding and charge capture. The front-end section of the healthcare revenue cycle flowchart begins with the patient appointment and continues until the end of the patient visit. These are both critical for regulatory compliance and claims processing. EDI is an acronym for Electronic Data Interchange, and ERA stands for Electronic Remittance Advice. EDI and ERA enrollment fits into this section along with the pricing and fee schedule for the organization. This section includes things such as provider credentialing and contract negotiations. However, it is still inherently important to the rest of the process. The pre-claim section of the healthcare revenue cycle is the smallest section. The five key sections of the healthcare revenue cycle flowchart include pre-claim, front-end, transactional, back-end, and efficiency. Some flowcharts are, however, more detailed than others. ![]() Of course, the names will vary between organizations, but the general contents of each section remain the same. While the healthcare revenue cycle flowchart is unique to each organization, some fundamental characteristics remain unchanged.įor instance, every healthcare revenue cycle flowchart has five sections. The revenue cycle starts when a patient makes an appointment for services, and it continues until full payment has been remitted. The best way to examine the process is with a healthcare revenue cycle flowchart. It also aids in the migration to value-based reimbursement and maximizes organizational performance and regulatory compliance while minimizing the cost per claim. A healthy medical revenue cycle process works in tandem with other software and automates revenue cycle management. Medical professionals currently spend more valuable time and resources on the revenue cycle than any other industry. An effective healthcare revenue cycle process maximizes organizational profits and keeps revenues pouring in. It takes considerable time and expertise to create and manage a well-maintained system that runs efficiently. Healthcare revenue cycle management is a complex and complicated process that can drain resources when not properly managed.
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