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Healthcare Revenue Cycle Management Basics

Flowchart showing healthcare revenue cycle management.What is revenue cycle management and why is it important for your health care organization? To answer these questions, let’s look more closely at what revenue cycle management entails.

Healthcare Revenue Cycle Management Definition

Healthcare revenue cycle management includes all clinical and administrative functions that contribute to the organization, maintenance, and collection of data on patient service revenue for a health care facility. Proper management streamlines practice profit, mitigates profit leaks, and provides a solid means for system analysis.

The Healthcare Revenue Cycle

Going more in-depth into revenue cycle management, there is a general medical revenue cycle that is employed. It consists of 1) gathering patient information, 2) coding the medical visit, 3) billing patients, 4) submitting claims to primary and secondary insurance providers, 5) eligibility verification, 6) following up on unpaid claims or claims with incorrect payment rates, 7) resolving denied claims, and 8) receiving reimbursements in a timely manner.

Human error is the biggest factor interrupting this revenue cycle in healthcare. When any one of these steps is dropped or lost due to incorrect documentation, coding, or procedure, the system falls apart. In this way, a practice loses thousands of dollars each year (and much more depending on clinic size).

Improved Revenue Cycle Billing

When it comes to revenue cycle billing, Billing Advantage is a reliable source for increased profitability, HIPAA compliance, and data security. Not to mention, your clinic maintains full access to the information.

First, Billing Advantage works with your clinic to design a system for sharing information in a way that is most convenient and secure for your needs. Then, we bill out your claims and make sure that each and every one gets paid. You may choose to take care of the data entry and coding or have Billing Advantage do it for you. If you’d like to handle the data yourself, Billing Advantage will help educate and train your data entry specialist on the Kareo system we employ. Either way, we minimize the human error in your revenue cycle management process.

If you have any questions about how to get started, contact a Billing Advantage specialist.


Donna Whipple Donna Whipple

Donna Whipple, Psy.D. is a clinical psychologist with over 30 years of management experience. She has particular interest and expertise in HIPAA and ethical treatment and business practices in a changing high tech industry. She has a particular talent in boiling down complex regulations so providers can understand and comply with them. As co-owner of Billing Advantage Inc., Donna is involved in all aspects of the company but her particular contributions to the business is in mentoring upper level managers and helping them be more effective in their leadership.


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