Revenue Cycle 101

An Explanation of Benefits (EOB) statement is a critical document in the healthcare revenue cycle. It provides detailed information about how a healthcare claim was processed by the insurance company. Here’s how to read and understand an EOB, with key sections explained in the context of the revenue cycle. Patient

In the revenue cycle management of healthcare services, denial codes are used to indicate why a claim was denied or rejected by an insurance company or payer. Understanding these codes is crucial for managing and resolving denied claims efficiently.

Using software & algorithms to automatically generate medical codes can significantly improve the billing process.

Revenue cycle employees contribute to the capture, coding, and collection of patient service revenue. Here are key jobs descriptions.

Clean claims rate” refers to the % of claims submitted to a payer that are processed & paid without any errors or rejections first time.

Workforce automation refers to the integration of technology solutions to automate tasks & processes performed manually by employees.

Workforce analytics are systematic analysis of employee data & performance metrics to enhance the effectiveness of operations for revenue generation.

This involves the strategic management & allocation of personnel resources to improve effectiveness in revenue-generating operations.

A critical component in RCM that can significantly impact reimbursement rates & operational efficiency. Be prepared & know what to expect.

Preventing coding denials in the healthcare revenue cycle is crucial for ensuring accurate billing and timely reimbursement.