Understanding Healthcare Revenue in 2021



Healthcare organizations aim to keep themselves updated and financially healthy. Each infrastructure proposes to follow a rigorous revenue cycle management system to maintain this financial health.


This article discusses all you need to know about healthcare revenue management and how it benefits in building the credibility of a healthcare organization.


What is the revenue cycle?


A revenue cycle refers to the effective procedure to keep a track of the revenue collected from the patients.


Or else put it, an optimal revenue cycle comprises all the clinical and administrative activities of a hospital facility for managing revenue added through their impeccable patient services.


A healthy revenue cycle lies at the heart of a successful hospital administration. It ensures the smooth submission and proceeding of bills and payments by hospitals’ regulations and policies.


Benefits of a Revenue Cycle


A revenue management cycle is immensely significant for a healthcare facility. Some of its underlying advantages are mentioned below:


Smooth Check-in and Check-out Process

First and foremost, a revenue cycle streamlines the procedures of check-in and check-out of the patients. This familiarizes the hospital staff with an optimal knowledge of their functioning dynamics.


Appropriate Management Claims

In this, a hospital collects revenue claims from the patients and process them through their software systems. It ensures the proper billing procedures and keeps the hospital records updated.


Insurance Follow-ups

Next, an adequate revenue cycle is responsible for maintaining follow-ups with insurance companies while insuring their timely reimbursements. It also takes care of the audit procedures to gain knowledge of the net claims and date of reimbursement.


Payor Management

It comprises the paid fee schedules, carrier provider numbers and NPI, benefit assessments, and other documentation procedures.


Denial Management

A revenue cycle optimizes the denial management system in case of excessive claim rates. The denial management process tries to assess the potential causes behind claim denial and aims to improve its service in the future.


Patient Collections

It constitutes the process of issuing patient bills and general forms to the patients to ease down their bill payment procedure. It also includes suitable payment plans, reviewing patient balanced payments before future appointments, etc.


Conduct Financial Clearance

In this step, the healthcare center verifies all patient information before the final clearance process where all bills are cleared and noting remains pending. It also ensures a thorough examination of the insurance policy claims and undertakes its smooth retrieval.


Charge Capture and Charge Entry

These two phases manage the billing dynamics of a patient. It initiates the process of fee payment for several utilities and all record is correctly entered in the database.


Patient Statements

The hospital facility issues clear and concise patient statements, which are basically automated notes on their condition and financial summary.


Leakage Points of a Revenue Cycle


Despite incredible revenue cycle management systems, there may be certain leakage points which this dynamic system is likely to encounter. These points are:


Denied appeals

There may be times when hospitals may suffer from appeals denials. The impact on the reputation of a healthcare center and prolongs the time required to complete a single revenue management cycle.


Underpaid claims

Hospitals may suffer from underpaid claims due to a paucity of fund availability with their patients. This may cause an unhealthy rapport between the hospital and their patients and lead to disputes.


Unverified insurance

Each healthcare facility tries its best to furnish verified insurance claims for their patients if any. However, unverified claims may add to a hospital’s dilemma has their system won’t be able to process them timely.


Further, it may also prolong a patient’s discharge and cause dismay across multiple levels.


Errors in billing, coding, and registration procedures

Technical errors are pretty common. However, hospitals should avoid such errors in registration and billing. This is because it leads to a negative image branding of healthcare infrastructure.


Therefore, hospitals that are unable to afford a decent IT facility can outsource the same to enjoy maximum benefits.


Insufficient staff training

Errors are bound to occur in case of inept technical staff. To avoid this menace, hospitals should recruit well-trained and professionally experienced staff at their reception desk and accounts section.


Moreover, they should also facilitate time to time training sessions for their technical staff to maintain the seamless flow of hospital functions.


Lack of Financial Policy

Last but not least; each healthcare center should have a proper financial policy for the smooth running of their facility. A robust financial policy offers appropriate guidelines for all those involved in a hospital system: doctors, technical staff, management staff, and the patients.


Besides, these guidelines also spread awareness among the insurance companies to cater timely reimbursements on behalf of the latter.


Thus, a healthcare revenue cycle occupies a relevant position in a hospital facility, It caters to developing the image credentials of healthcare infrastructure and hikes the worthiness of the physicians and the other medical and technical staff working with it.


ZEPNURhealth highly recommends the service of a healthy revenue cycle for managing patient data. We are a Bangalore based company facilitating effortless solutions for procuring medical and healthcare equipment online.


Get in touch for affordable quotes and timely delivery of your procurable items.

 

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