The healthcare revenue cycle is the process where funds are generated through the various services rendered to patients. The cycle has three parts, namely patient scheduling and registration, claims submission, and payment posting. It begins when the individual calls for an appointment and ends when all the payments are collected. At this point, the healthcare institution gathers and verifies vital information such as insurance and other payment options. The pre-registration process is essential in establishing information about the patient and their account to make sure that they have the financial capability to pay for services. The employees at the healthcare facility create a patients account which includes details such as previous medical history and insurance coverage. The treatment received must be accompanied by the proper ICD-10 code (Balgrosky, 2019). The patient is then attended to by the doctor, and the most appropriate diagnosis and treatment are offered, in the form of charts and codes that are later submitted to the insurance company (Balgrosky, 2019). Before the claims are sent to the company, the health facility's coding experts check the codes against the insurance firm to ensure there are no errors.
After the services are rendered and the claims sent off to the insurance company for reimbursement, the last step is the payment. It is the sole responsibility of the billing team to collect the payment since they understand the coding process, including the appeal procedure to follow in case of a claim denial (Balgrosky, 2019). The compliance of patients relies on the institution's capability of keeping them informed in every step. The major problem comes in coding since there are up to 70,000 codes to choose from in the ICD-10 (Hirsch et al., 2016). For this reason, a coder must comprehend the patient's chart to assign the appropriate code, and the healthcare provider must be careful in documenting the exact diagnosis and treatment. An incorrect code can result in claim denials, and insufficient reimbursement, which is why a medical biller must check if the codes applied are billable (Hirsch et al., 2016). If any deficits occur in the payment process, it is recommended that the patient settles the remaining balance.
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References
Balgrosky, J. A. (2019). Understanding Health Information Systems for the Health Professions . Burlington, MA: Jones & Bartlett Learning.
Hirsch, J., Nicola, G., McGinty, G., Liu, R., Barr, R., Chittle, M., & Manchikanti, L. (2016). ICD-10: History and Context. American Journal of Neuroradiology , 37 (4), 596-599.
