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Healthcare Revenue Cycle Management

By DeVry University

February 9, 2022

4 min read

Every healthcare organization has to have a plan for how they approach revenue cycle management. This vital practice enables companies to monitor the revenue they receive from patients from the beginning of their care process to the end, providing them with data that facilities can use to improve practices and patient care.

If you're interested in working in the healthcare field in a non-clinical role, then healthcare revenue cycle management might be a career to consider. Revenue cycle management is an important business measure, as it helps ensure that patients aren't getting overbilled and that your care facility is being properly paid by insurance companies.

In this article, we'll explain the basics of healthcare revenue cycle management, explore how medical billing and coding play a role in the cycle and more as we explore the following sections:

What is Healthcare Revenue Cycle Management?

Healthcare revenue cycle management is the process of tracking and analyzing revenue received from patients during the course of their care process. The cycle begins when the first appointments are booked and concludes once the final balance of their cost of care is paid.

Like an accounting process in business, healthcare revenue cycle management considers a range of factors, including what it costs a facility to provide care to the patient. By analyzing these factors alongside the revenue generated during the cycle, care facilities can identify which procedures or methods lead to generating the most revenue.

Once this information is in hand, hospital managers and other decision makers at a care facility can use it to decide where funds can be allocated and how to increase revenue to fund a larger range of services to meet patient needs.

What are the Main Steps in Healthcare Revenue Cycle Management?

The process of healthcare revenue cycle management can be simplified into three steps: registration, medical coding and medical billing.

Here's a brief explanation of what each step includes:

    • Registration: 

    The healthcare revenue cycle management process begins as soon as a patient schedules their first appointment. This step requires the care facility to gather all of the information they will need to treat and bill the patient, such as the patient's name, address, contact information, insurance and any medical records. While the patient is responsible for providing much of this information, it's the responsibility of the care provider to ensure that all the information they receive is accurate and up to date.

    • Medical coding: 

    During this process, the care facility's medical coding staff uses standardized medical coding methods to apply codes to the procedures that a patient receives. When done properly, medical coding helps to keep the care process moving smoothly without administrative interruption.

    • Medical billing:

    Finally, the healthcare revenue cycle management process concludes when the patient pays their final bill. To ensure that the bill they receive is accurate, a medical billing professional reviews the work of the medical coder and scrubs the bill for any potential errors. By scrubbing for errors, they can ensure that the bill the patient is provided does not get rejected by their insurance company, making the entire process smoother for all parties involved

How is Healthcare Revenue Cycle Management Relevant to Medical Billing and Coding?

Medical billing and medical coding both play a critical role in healthcare revenue cycle management, particularly in the second and third steps of the cycle.

Both medical billing and medical coding make the revenue process run more smoothly by having highly trained, dedicated professionals who can properly employ code procedures and input insurance details and finalize bills.

Thinking About a Career in Medical Billing and Coding?

If you're interested in learning more about healthcare revenue cycle management, what medical billers and coders do or want to pursue a career in medical billing and coding, then DeVry can help. Our Undergraduate Certificate in Medical Billing and Coding is designed to help you stay up to date with current industry trends, learn how to implement billing and coding procedures in real-world situations and develop a better understanding of the healthcare field. Classes are 100% online and start every 8 weeks.

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