What Are the Steps in the Medical Billing Revenue Cycle? 

The medical billing revenue cycle is the series of steps you take to process healthcare payments for your organization. While there may be some minor variations, the process is generally the same for almost all ambulatory medical providers.  

Still, it’s important to understand how the medical billing process works, so you can work to improve and streamline the process for your staff and patients. TempDev helps you understand and implement best practices for your medical billing to help you achieve success. Here’s a quick overview of what the medical billing revenue cycle is. Then we’ll go through the steps in the process.  

What Is the Medical Billing Revenue Cycle?  

The medical billing revenue cycle can be confusing. It involves every contact from the time you connect with your patient for the first time until you process their claim and receive payment. With so many complications in the process, you may use multiple vendors as part of your revenue cycle, like 70 percent of healthcare organizations. 

Beyond the complications, you also face the mounting issue of denied claims. It’s common. Some 90 percent of the errors are due to simple issues with incorrect data, missing details, late submissions, duplications, lack of pre-authorization, or insufficient documentation. Yet, 65 percent of claims are never resubmitted.  

Whether you’re looking for consulting, support, or even temporary billing help, TempDev offers the services you need to identify and fix the problems that are affecting your financial health.

Medical Billing Revenue Cycle: Pre-Register

In this pre-registration step of the revenue cycle, you gather the patient’s demographic information, their insurance details, and other data, while determining their eligibility. In many cases, this is the step where you discuss the copay and other financial obligations, as well as offer insight into your cancellation policy to avoid future confusion. Many organizations also obtain authorizations for the procedures from the payer. It’s important to get all these details correct, so you avoid the common problem of medical billing errors.  

Medical Billing Revenue Cycle: Good Faith Estimates & Pre-Estimation

With the new legislation, The No Surprise Billing Act, centered around ensuring patients know their responsibility prior to visiting the physician, many offices are providing self-pay patients with a Good Faith Estimate to outline expected costs. Offices may also decide to call patients with insurance Ito inform them of expected copays, coinsurance, or deductibles that will need to be paid prior to receiving services.

Medical Billing Revenue Cycle: Register

The registration is often when you ask your patient to verify the details on their record while asking them to sign any HIPAA or other financial firms. You may collect the co-pay at this stage in the medical billing process or you may wait until the end of the appointment. Medical billing errors can negatively affect your practice, so it’s important to avoid them whenever possible. Front desks will often collect and post copays, co-insurance, and deductibles during the registration process.

Medical Billing Revenue Cycle: Capture Charges

This can be the stage of the cycle where you capture the charges either from the EHR, a mobile application, coding, or a paper superbill. You'll also apply the upfront copay transactions to the charges before they get sent out. To get to this point, you’ll need to make sure that you’re using the correct billing codes so the charges will be applied correctly. At this point, it’s also another opportunity to double-check the patient’s demographics and insurance details.

Medical Billing Revenue Cycle: Submit Claim 

At this point in the process, you’ll likely send the patient’s claim to the insurance provider. Before you send the claim, you can take the opportunity to scrub it to make sure it’s clean and correct. Your goal is to deliver a claim that doesn’t have any issues, so your payment will be processed more quickly. TempDev can help you to improve your workflow processes and systems to prevent medical billing errors.

Medical Billing Revenue Cycle: Process the Remittance

In the remittance step of the medical billing revenue cycle, you’ll receive either a paper or electronic explanation of benefits (EOB), and the payer will indicate how much they are contracted to pay for the services. Review the remittance and be sure to correct any errors, oversights, and inconsistencies. It’s also a good time to review those avoidable write-offs.   

Medical Billing Revenue Cycle: Follow Up With Insurance

Just because a claim was denied doesn’t mean you should let it go. You still can follow up with the insurance provider to determine why it was denied, appeal and resubmit the claim, and implement important processes and procedures that will hopefully avoid those denials in the future.  

Medical Billing Revenue Cycle: Collect Payment From Patient

Ultimately, you will come to the point in the revenue cycle when you collect the final payment from your patient. This process is easier if you collect the co-payment at the beginning of the intake process for an appointment or the end of the appointment before they leave the office. You can still send out a statement to your patient promptly to ensure you get the payment processed as expeditiously as possible. Sending out these statements and reminders electronically, improves the likelihood of you being paid.

How TempDev Can Help With Your Revenue Cycle Needs 

TempDev’s revenue cycle consultants offer support to you with your revenue cycle. If you’re struggling with backlogged posting, bad debt, credit balances, denied claims, or other recycle cycle issues, TempDev offers the support you need. With Revenue Cycle Optimization, Flat Rate Billers, and Practice Management Assessment, we focus on identifying your unique medical billing challenges. 

At TempDev, we deliver the targeted revenue cycle solutions you need the most. We offer the tools and resources you need, with top tips and tricks that will make your medical billing easier and more efficient. With all our services and support, we work to ensure your success. 

Contact us here or by calling us at 888-TEMP-DEV to get the help you need with your revenue cycle management.