Health care providers are increasingly developing management principles due to an emerging hospital business environment where strict regulation in addition to stringent billing requirements has been instituted. However, healthcare finance is unique due to the fact that patients do not choose to be patients, therefore, making services to be provided before collection of revenue with no option of taking back the goods or services should revenue not be collected ( Green, 2018) .
Revenue contributors
Healthcare finance has notable contributor’s mainly third parties such as insurance providers, private care organizations, and the government through health plans such as Medicare. Additionally, individual patients can also make contributions should they not have an insurance or health plan.
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Revenue generation
Hospitals generate revenue through the provision of care services which are paid either by patients or third-party payers. As such the healthcare providers ought to ensure that the quality of services provided is high within the provision of both medical and non-medical services (“ Revenue Cycle versus Reimbursement Cycle”, 2009) . The finance department is critically involved in the revenue and reimbursement process by ensuring that billing policies, as well as procedures, are adequately implemented to ensure accurate and timely billing and claims (Michael & Harrington, 2015) . In some instances revenues may not be paid leading to follow-ups through denials and claims recovery processes where claims that have been denied are corrected and resubmitted. When such denied revenues are made they are posted as cash receivables or bad debts should they not be paid.
Revenue and reimbursement
Significant relationships exist between revenue collected and reimbursement noting that hospitals that have comprehensive revenue cycle management are able to increase their revenue collection through reimbursement. The collection of insurance or health plan information that a client is using proves largely important in enhancing the process of collecting revenue and reimbursement ( Rauscher & Wheeler, 2008) . Filing claims and making submissions with regard to such claims is an important factor of the reimbursement process. Hospitals need to make improvements with regard to the process of filing and making claims to ensure that reimbursements are done on a timely and efficient manner. It is necessary for care facilities to maintain a charge master which promotes the integrity of the revenue cycle by using codes which are automatically decoded while evaluating claims and indicate the services a client has received thus placing the claims within certain price categories to ensure that care providers do not charge exorbitant prices for services.
References
Faculty St Joseph's College of Maine Department of Health Administration Standish Maine Michael K Harrington, & Harrington, M. K. (2015). Health Care Finance and the Mechanics of Insurance and Reimbursement . Burlington, MA: Jones & Bartlett Publishers.
Green, M. A. (2018). Understanding Health Insurance: A Guide to Billing and Reimbursement . Boston, MA: Cengage Learning.
Rauscher, S., & Wheeler, J. R. (2008). Effective Hospital Revenue Cycle Management: Is There a Trade-off Between the Amount of Patient Revenue and the Speed of Revenue Collection? Journal of Healthcare Management , 53 (6), 392-404. doi:10.1097/00115514-200811000-00008
Revenue Cycle versus Reimbursement Cycle. (2009). Healthcare Payment Systems , 65-77. doi:10.1201/b10253-5
