Reimbursement and the Revenue Cycle

Reimbursement and the Revenue Cycle

Am writing a white paper and so far that what I have …the patient care to an effective level. To obtain an effective revenue cycle an implementation of a successful secure and constructed revenue cycle must be established. Revenue cycle involves patients, providers, and payers. The process begins the patient visit for care services. The major components of the revenue cycle are divided into; front-end process, middle process, and back-end process. The front-end part begin with registration which involves the payer negotiation, that occurs outside the patient encounter, insurance verification, demographics information and prior authorization. The middle process involves case management, charge capture, hard and soft coding that happens in the diagnosis in clinical documentation. The back end involves revenue cycle that happens in the patient financial service area. Its where the billing, sending payments, making correction on any claims that were denied for any errors occurred. All these procedures go hand in hand for the healthcare organization to function as it relies on the insurance and patient reimbursement to function in everyday activities.

My paper will talk about Cambridge Health Alliance (CHA) its located in the heart of Boston Ma, with a well know and respected reputation that provides innovative and academic healthcare system serving Cambridge, Sommerville, and Boston’s metro-north communities. It has three hospital campus, an efficient and extensive primary care network, CHA provides high-quality care to a diverse patient population.  Many of these CHA patients rely on the healthcare facility for assistance for their medical needs. Therefore, reimbursement is vital to this hospital to function and be profitable. Basically, reimbursement occurs in the process of payment with the money spent or lost. Every revenue cycle process is a step by step that involves several departments.  Eventually, each revenue cycle begins with the “front end”. The front-end process is the beginning of the process that occurs prior to the admission of the patient. The payer negotiation has already been implemented through insurance companies, or financial service administrators.  The next step needs accuracy due to the success of the flow of the cycle. The patient checks in and is registered. The patient can schedule an appointment over the phone or visit in person. All demographics information will be entered and put into the patient’s chart or medical record. Demographic information is carefully documented, as this information is needed for the billing and reimbursement process.