The Revenue Cycle

In order to remove unwanted costs and inefficiencies from your practice, an understanding of the revenue cycle must be achieved. Below is a flowlist showing the necessary steps needed to shorten the revenue cycle and produce optimal results. 

Step 1 : Insurance Pre-Authorization

• demographics
• insurance authorizations

Step 2 : Patient Check-In

• patient co-payments
• reconcile account balances

Step 3 : Charge Entry & Capture

• service capture (charge tickets)
• insurance documentation
• identify CPT and ICD-9 codes
• identify necessary modifiers
• review chart and code claim and/or operative notes

Step 4 : Claim Processing

• electronic submission
• generate patient statements
• review and edit/submit claim

Step 5 : Payment Posting

• post & balance payments
• denials, refunds & appeals
• prepare secondary claims

Step 6 : Follow Up

• request additional info
• update claim status
• payment progress reports

Step 7 : Denial Management

• "clean claims" paid and posted
• if not clean, claims reviewed, edited, and resubmitted
• claim appeals process
• submit necessary insurance appeal

Step 8 : Collections

• collect remaining insurance payments
• collect patient payments
• review & collect aging A/R

Step 9 : Quality Control

• benchmarking
• review receipt flow
• review A/R flow