Critical Revenue Cycle Steps to Master

In healthcare, the revenue cycle encompasses a series of critical functions that are essential for the financial health and sustainability of many different organizations. Our team at Signature Performance is fully equipped to tackle any revenue cycle challenges you may have with over 20 years of healthcare experience in both the federal and commercial sectors. By consulting a revenue cycle expert like Signature Performance, you can more efficiently manage your organization's needs, improve your financial performance and can allocate your time and resources to what is most important to your organizational goals. 

Without an optimized Revenue Cycle, your organization is at an increased risk of occurring higher administrative costs and burdens as well as a decrease in overall revenue. With many steps and systems in place, it is pivotal to the success of any healthcare organization that they have a fully functioning, well-oiled machine when it comes to their revenue cycle operations. Even one small, mis-aligned process could result in a huge loss of cash flow or revenue. With a partner like Signature at the helm of your Revenue Cycle operations, you can ensure your revenue cycle is running smoothly and can count on our team to increase your bottom line and improve your administrative functions. 

Five Revenue Cycle Functions to Ensure Optimization

Patient Access & Insurance Eligibility/Discovery

The revenue cycle begins with Patient Access or registration and scheduling. Accurate capture of patient demographic and insurance information is crucial for successful billing and reimbursement practices later on in the revenue cycle. Did you know that nearly 50% of Patient Access information is captured incorrectly? By ensuring that patients provide correct and complete information, they can also better understand their up-front financial responsibilities and can help reduce future billing and collections errors. 

Similarly,  verifying patients' insurance coverage and eligibility is essential to determining the extent of coverage for the services rendered. It helps prevent claim denials and reduces the risk of billing patients for services that are not covered by their insurance plans. A lack of consistency in the discovery process can lead to long-term issues down the road that could be easily avoidable. 

Medical Coding

Medical coding involves translating diagnoses, procedures, and services into universally adopted codes to ensure proper billing and reimbursement. Accurate coding is essential as it directly impacts the amount insurers will pay for the services a patient received. For example, if a provider codes the patient encounter as a one-time visit when in reality it was a second or third visit, they run the risk of undercharging for the services rendered. Proper documentation and adherence to coding guidelines is crucial to avoiding claim denials and compliance issues for the healthcare organization. By enlisting highly-specialized coding experts, like Signature Performance, you can count on your medical coding to be done correctly, the first time ultimately improving the likelihood of proper payment and reimbursement.

Claim Submission, Management and Follow-up

Submitting claims to insurance payers in a timely and accurate manner is critical for proper reimbursement. This process involves compiling all necessary documentation including patient information, insurance details, and coding documentation, to submit the final claims. Managing the status of claims throughout the reimbursement process is essential to ensure they are paid efficiently and accurately. This includes tracking the status of submitted claims, identifying and resolving claim errors or denials, and following up with payers to expedite payment should there be delays. 

By working with Signature Performance, you can trust that our solutions will allow you to  reallocate your valuable resources and time to focus on patient care rather than paperwork. Our team of medical claims editing experts stay up-to-date on the latest coding and billing changes, payer requirements, and industry trends to help you keep your revenue cycle operating as efficiently and effectively as possible.

Payment Posting and Payer Relations

Posting payments received from insurance payers and patients accurately and promptly is essential for maintaining accurate financial records. It involves reconciling payments with claims, identifying discrepancies, and applying payments to the appropriate accounts receivable. A partner like Signature Performance can also help manage payer relations in ensuring there are minimal to no delays in payments due to regulatory issues and underpayments. 

Denial Management, Appeals, and Patient Billing/Collections

Denials occur when insurance payers refuse to reimburse healthcare organizations for services provided during patient encounters. Effective denial management involves identifying the root causes of denials, appealing denied claims when appropriate, and implementing strategies to prevent future denials. 

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Once the denial management process is complete, patients can then be billed for their correct share of the healthcare costs. It is essential to the health of your organization that the payments are collected in a timely manner to ensure revenue generation and improve cash flow. By partnering with Signature, you can reduce delays in revenue collections, effectively manage your payer responses and can identify trends and reasons for any denials you may routinely experience. 

Each of these revenue cycle functions plays a vital role in ensuring the financial viability and success of healthcare organizations. By effectively managing these functions, healthcare organizations can optimize revenue capture, improve cash flow, and ultimately enhance their ability to deliver high-quality patient care. The Revenue Cycle Experts at Signature Performance are well-versed in optimizing every stage of the cycle and can help minimize delays and gaps in your organization. By working with a partner like Signature, you can focus your time and resources on what is most important to you and can rest easy knowing our team of experts have the people, processes, and technology to maximize your revenue cycle.

To learn more about our Revenue Cycle capabilities, click here.