While the chief function of any health caregiving facility is to make sick people well and preserve good health, it’s an inescapable fact that money is a crucial element in keeping those institutions open. As altruistic as the aims of such places are, people need to be paid, equipment purchased, and the lights kept on. Failure to do so results in a shutdown, much to the detriment of all parties concerned.
Therefore, it’s imperative to keep money coming in, and that’s where a healthy revenue cycle comes in. Otherwise, cash flow problems ensue. Let’s take a look at revenue cycles and how to address any damage.
Revenue cycles, according to the Healthcare Financial Management Association, are defined as “All administrative and clinical functions that contribute to the capture, management, and the collection of patient service revenue.” Therefore, a revenue cycle is present from the start to the closing of a patient’s account.
Consider a revenue cycle to be like a pocket watch; made up of distinct parts designed to mesh and work together. The malfunction of any one part can result in the entire mechanism breaking down.
According to the article “Is Your Revenue Cycle Broken? Here’s 5 Steps to Fix It”, one effective way of dealing with a broken revenue cycle is to consider each phase of the cycle as a separate entity. By doing so, you can focus on the problems of just one part of the cycle exclusively. Deal with them without getting stretched too thin, then, once you’ve resolved that particular phase’s problems, move on to the next.
You can’t process claims if the information is incorrect or incomplete. In fact, nothing guarantees a swift rejection of a reimbursement claim than the wrong information. In this age of rampant insurance and claims fraud, no one wants to take chances.
That’s why your revenue cycle team must take the time needed to review the integrity of new data and make sure that things are entered correctly. Catching errors beforehand means faster revenue collection.
Whenever possible, make sure that many time-consuming tasks are handled ahead of time, and that includes establishing a patient’s insurance, coverage limits, special conditions, etc. By taking care of these things in advance, your staff ends up freeing time to devote more attention to the later stages such as claim submission, remittance processing, and rejections.
Finally, there’s something to be said about analyzing your entire revenue cycle and seeing where the snags are, a sort of dry run if you will. By taking apart and studying the processes of each phase of the revenue cycle, you can usually determine the problem. It’s much in the same way as a mechanic disassembles an engine in order to find the source of that odd noise. Perhaps it’s a case of outdated or redundant procedures.
Even the best hospital or clinic needs to be kept afloat by a steady stream of income. By isolating the problems in your broken revenue cycle, you can be sure to keep your organization running smoothly, and perhaps even having the option of expanding!