Introduction
We’ve talked before about what revenue cycle management is and why it’s important, but you may still be wondering what a successful revenue cycle looks like. What are the components that make up a revenue cycle and how do they come together to produce success? Let’s take a look at each essential component of the cycle and how they work together to drive your healthcare facility’s overall financial performance.
Chargemaster
Chargemaster is the electronic database used by healthcare providers to determine the prices of procedures and services. It’s also sometimes referred to as a rate card or fee schedule. Chargemasters are created by hospitals, clinics and other providers to determine how much they will charge for their services. The data in these chargemasters change periodically to reflect changes in the cost of providing care or upgrading equipment.
Pricing
No matter how good you are at providing excellent care, if your office is not set up to collect money, your revenue cycle will suffer.
To be successful in managing the revenue cycle, it’s essential that you understand how pricing plays a role in your success—and what you can do to ensure that patients pay for their treatments.
Pricing is an essential component of revenue cycle success because it helps determine payment amounts for services. In fact, pricing is so important that many healthcare providers spend years developing their own complex systems and algorithms to determine fair prices for each procedure or treatment they offer patients.
Revenue Capture/Control
Revenue control and revenue capture are two sides of the same coin. Both refer to the process of managing revenue, which is one of the key components of a successful revenue cycle. If you want to create a successful revenue cycle, it’s crucial that you understand how these terms fit together and how they differ from each other.
Revenue control refers specifically to what happens once a customer has paid for their product or service—that is, it refers to ensuring that customers pay their bills on time and in full. Revenue capture refers more broadly to ensuring that all payments are collected at all times, including when they come from sources other than customers (such as claims against insurance companies).
Registration/Scheduling
Registration and scheduling is the initial step in the revenue cycle. It involves registering new patients, scheduling appointments and reminding patients of upcoming appointments. You’ll also need to be able to reschedule or cancel appointments as needed.
Successful revenue cycle management requires a system that can manage all of these steps with ease, so you can focus on providing your services and collecting payments from your patients instead of dealing with the logistics of running an office.
Coding
Coding is a key element of revenue cycle management. It is used to track and report on claims, which helps ensure compliance with federal and state regulations. It also ensures that your patients are properly reimbursed for their care at the time of service.
In sum, coding plays an important role in helping you manage your revenue cycle, as well as ensuring compliance and reimbursement for your patients’ care.
Business Office
The Business Office is the link between patient care and revenue generation. That means they’re responsible for managing billing, collections and accounts receivable. They work with patients on questions or concerns about their bills as well.
Customer Service
The best way to ensure that your revenue cycle is running smoothly is to provide customer service that is consistent with the brand and is delivered in a timely manner.
Customer service that provides solutions for customers in a timely manner will help you achieve better ROI on all aspects of your revenue cycle. Your goal should be to deliver solutions as quickly as possible, preferably within 24 hours, so you can avoid the “no-purchase” decision from happening at all. This means responding quickly and accurately when someone has an issue or question regarding their product or service purchase.
Successful revenue cycles are based on strong foundational components that support each other and contribute to the success
To achieve a successful revenue cycle, it is important to understand that different components of your revenue cycle work together and support each other. You can’t have one without another; they are all necessary for success. Strong foundational components like Chargemaster, Pricing, Revenue Capture/Control and Registration/Scheduling are essential in achieving great results.
The first step in building a successful revenue cycle is to establish a solid foundation: the Chargemaster. This document is an itemized list of all medical supply products and services provided by your organization with associated costs per unit or service rendered along with any discounts or allowances for specific groups such as Medicare or Medicaid patients based on reimbursement rates from third-party payers (insurers).
Conclusion
In short, a robust revenue cycle helps to ensure that your organization can continue to provide quality care for patients by covering the costs of operating successfully. A successful revenue cycle is built upon a foundation of strong individual components that work together to promote accurate and timely billing. And, having visibility into these foundational aspects allows you to see how they are performing as a whole, so you can make adjustments or even discover new process improvements that will ultimately lead to increased reimbursement and patient satisfaction.
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