Revenue Cycle Management in an Established Clinic
While most medical institutions’ main objective is to provide quality care to their patients, this is not possible when they do not have a billing system that helps the collect enough revenue to pay all their expenses. Apart from paying the expenses, the revenue should be enough to make new developments in the clinic to increase the quality of the services delivered (Rosario, 2018). To achieve this, hospitals need to develop a revenue collection plan that makes sure they achieve their objectives while being fair to the patients. One aspect of quality service delivery is ensuring that the process is as easy as possible.
There are several steps involved in a revenue cycle: patient registration, insurance verification, medical documentation, chart review, coding, claim submission, payment posting, accounts receivables, and collections (Dennis, 2017). These steps have to run smoothly since a wrong entry in one could lead to material problems throughout the system.
Proposed step by step process of the revenue cycle
Patient registration – the first step would be to use an Electronic Health Record (EHR) System to record the patient’s name, demographic characteristics, and payment options. The check-in staff will use the system to check the patient’s insurance and verify it before allowing them to the next step.
Medical documentation- this step encompasses medical documentation, chart review and coding, and claim submission. After registration, the patient proceeds to the doctor’s office where they are assessed, and their medical condition is determined. In this step, the EHR system is fed with the patient’s medical history, diagnosis, procedures performed, medication is given, and other services ordered.
Check out- this step encompasses payments posting. The doctor posts the services provided and the medication given to the patient to the check-out staff. The check-out staff look through the services and prepare a receipt consisting of the consultation fee, the services provided, and the patient’s discounts.
Billing- the billing staff is supposed to make the necessary adjustments are made to the payments made. The actual payments are adjusted for the given discounts and any other payments that the patient could have made.
Reporting- the reporting staff helps develop financial statements in accordance with the federal and state requirements.
Pricing structure
Since the clinic has an established doctor, the best pricing structure is the use of demand. Through this system, the clinic’s costs are covered, but other non-tangible factors such as the patient’s confidence in the doctor are factored in. Prices in healthcare are affected by the costs of operation of the clinic, the demand and supply dynamics of the economic environment, and in some cases, the proficiency of the doctor (Achar, 2017). The prices set by the clinic should be fair to the patients while offering incentives for the workers and the doctor. The patients should be able to make their payments either through insurance or self-pay.
When insurance companies are involved, various factors should be considered. The first factor is the goal of the clinic. Proper background research should be performed on insurance companies so that the clinic can work with the companies whose goals align with the goals of the clinic. The size of the clinic also matters. The larger the clinic, the easier it is to negotiate when it is a small clinic, longer contract terms are better to avoid the bureaucracies of forming a new contract. The background check information should also involve the experiences of other healthcare centers with the insurance company (Kauffman, 2015). These factors ensure better relationships between the clinic and the payers.
Patients that are uninsured and are not eligible for any government program can receive assistance from the clinic. The patients who can be provided with assistance at the clinic are patients who present an emergency that seriously endangers their lives or the life of another, for example, a pregnant woman and the life of their unborn child. Self-pay patients should be approached with respect and professionalism before they are made aware of their payment options. To make it easier for the patients, different modes of payment should be available at the hospital to make the experience easier.
An installed billing software system is way better than a web-based software system. An installed system can be tailored towards the needs of the clinic, and it can be free of delays caused by internet connectivity. Web-based software depends on the internet. While that makes it possible for the information to be obtained from any computer, it can be slower when internet connectivity is slow. The issue of information being accessed from any computer also undermines a healthcare provider’s need to ensure privacy for their patients.
Proper revenue cycle management uncomplicates the process of billing and creation of financial reports since all information is found on one system. Since the bill has a designated line of progression, it can be tracked easily when there is a complication. The patients also benefit since they do not have to go through too many steps before receiving the primary services that they needed. Since the system is electronic, it is much faster, thus reducing the amount of time the patient has to spend waiting for their turn.
References
Achar, S. (2017). Pricing Strategies with Particular Reference to Healthcare. Global Management Accountants Conference.
Dennis, A. (2017, February 3). REVENUE CYCLE MANAGEMENT.
Kauffman, J. (2015). How to work with insurance companies. Neurology Clinical Practice, 448-453.
Rosario, C. (2018, June 5). A Complete Walkthrough of the Healthcare Revenue Cycle Management Steps. Retrieved from Advanced Data Systems Corporation: https://www.adsc.com/blog/a-complete-walkthrough-of-the-healthcare-revenue-cycle-management-steps