The Revenue Cycle

In order to remove unwanted costs and inefficiencies from your practice, an understanding of the revenue cycle must be achieved. Below is a flowlist showing the necessary steps needed to shorten the revenue cycle and produce optimal results.

Step 1 : Insurance Pre-Authorization
•  demographics
•  insurance authorizations

Step 2 : Patient Check-In
•  patient co-payments
•  reconcile account balances
•  in & out patient services

Step 3 : Charge Entry & Capture
•  service capture (charge tickets)
•  insurance documentation
•  identify CPT and ICD-9 codes
•  identify necessary modifiers
•  review chart and code claim and/or operative notes

Step 4 : Claim Processing
•  electronic submission
•  generate patient statements
•  review and edit/submit claim

Step 5 : Payment Posting
•  post & balance payments
•  denials, refunds & appeals
•  prepare secondary claims

Step 6 : Follow Up
•  request additional info
•  update claim status
•  payment progress reports

Step 7 : Denial Management
•  clean claims paid and posted
•  not clean reviewed, edited, and resubmitted
•  claim appeals process
•  submit necessary insurance appeal

Step 8 : Collections
•  collect remaining insurance payments
•  collect patient payments
•  review & collect aging A/R

Step 9 : Quality Control
•  benchmarking
•  review receipt flow
•  review A/R flow

Back to Improve Your A/R