This week we learned about the revenue, expenditure, and production cycle. I
found this chapter very interesting since I work in the food industry and some
of the examples, we cover this week pertain to our daily operation. I decided to
do my discussion on the Revenue cycle. The article is called Revenue Cycle
Management- how policies and procedures provide a solid and effective
foundation. This article talks about the Healthcare revenue cycle which is the
financial process facilities use to manage the administrative and clinical
functions associated with claims processing, payment and revenue generation
and are an integral part of a healthcare organization’s success. (Thomas, 2022)
Processes in the revenue cycle include:
1. Patient scheduling
2. Benefit and eligibility verification
3. Patient encounter
4. Medical documentation
5. Medical coding
6. Charge capture
7. Claims generation and submission
8. Cash and payment posting
9. Secondary billing
10. Patient billing
11. Accounts receivable
12. Denials management
13. Auditing, reporting, and benchmarking
It is important for healthcare business to have a good AIS system in place to
improve efficiency and effectiveness of the organization’s revenue cycle
activities. The revenue cycle compliance program promotes compliance with
applicable laws, regulation, and policies pertaining to billing and
reimbursement of professional, hospital, and clinical research activities, it will
reduce the potential for noncompliance with government and other third-party
payors by fostering the elements of an effective compliance across the
healthcare organization. It is important to that the AIS system information is
set up correctly to avoid billing errors for examples: Failing to bill, billing
errors, posting errors in accounts receivable, inaccurate billing amounts. It’s
important to have proper reconciliation procedures in place to avoid fraud.
Bibliography
Thomas, S. E. (2022). Revenue Cycle Management . Journal of Health Care
compliance, 35-37.
Revenue Cycle Management Compliance--How Policies and Procedures
Provide a ...: Multi-Search (snhu.edu)
