Revenue Cycle 101

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.

Preventing coordination of benefits denials is essential for maximizing revenue & ensuring that patients are covered for medical expenses.

Involves reconciling the financial records of healthcare providers & reporting on the revenue generated from patient services.

Patient billing and collection refer to the process of invoicing patients for the services they have received from healthcare providers and collecting payment for those services.

Denials in insurance occur when an insurance company or payer refuses to reimburse or pay for a submitted healthcare claim.

Key stages in the healthcare claims process that occur after a claim is submitted to an insurance company or government payer.

Submitting healthcare claims to insurance companies or government payers to request reimbursement for the services provided to patients.

Coding and charge capture are crucial components of the revenue cycle in healthcare. They involve the assignment of specific codes to medical procedures, diagnoses, and services provided to patients, which are then used for accurate billing and reimbursement purposes.

Service delivery includes the activities involved in diagnosing, treating, and caring for patients to address their medical needs.