Revenue cycle operations
There are three functional areas in the
revenue cycle (improve revenue cycle):
front end, middle, and back end.
FRONT-END PROCESSES
• Pre-registration
• Scheduling
• Patient Access and Registration
• Pre-authorization,
Pre-certification,
and Insurance Verification.
• Point-of-Service
Collections
and
Financial Counseling.
MIDDLE PROCESSES
• Clinical Documentation/Medical Records.
• Charge Capture and Coding.
• Charge Master and Master Patient Index.
• Late Charge Reductions.
• Case Management.
BACK-END PROCESSES
• Billing: Primary and Secondary Insurance.
• Reimbursement, Posting, Refunds, and
Adjustments.
• Follow-Up/Tracking.
• Denial Management.
• Bad Debt and Collections.
• Customer Service: Front, Middle, and End
Processes.
• Management Expectations.
Quality measurements and metrics are important
elements in the evaluation cycle, especially related to
process improvement, for several reasons:
• Metrics support the analysis, recommendations, and
conclusions—you cannot argue with quantifiable data.
• Metrics establish the tone where both negative and
positive outcomes are measured.
• Metrics provide a mechanism for understanding
outcomes and a way to obtain employee buy-in to
change.
• Metrics establish accountability, especially for
those employees not performing to par.
• Metrics provide data to leadership, enabling
them to focus of issues, problems, and
resolutions.
• Metrics are also used as a means to celebrate
improvement once attained.