Institute:Office of National Coordinator (ONC) Workforce Training Curriculum
Component:Introduction to Health Care and Public Health in the U.S.
Unit:Financing Health Care - Part 2
Lecture:The Revenue Cycle of Various Health Care Enterprises
Slide content:Revenue Cycle Overview Appointment scheduled Registration: Demographic and insurance info Services provided Charge capture Coding Claim submission: paper or electronic Reimbursement received Final settlement with patient 11
Slide notes:The revenue cycle is a standard set of activities and events that produce revenue or income for a provider. Each organization determines the administrative and management tasks pertinent to their particular operational circumstances. The tasks for a serious case in the Emergency Department of a hospital will be handled differently than a direct admission to the hospital, as will the tasks in a physicians office. In each situation, the process of the revenue cycle is the same. The process begins with the patient or provider determining that health care services are needed, and scheduling an appointment. At the health care facility, demographic information and insurance information are collected when the patient registers. The health care organization confirms the terms of the insurance coverage with the third-party payor, either electronically or by telephone. During this process, the provider obtains information about patient deductibles, copayments, and coinsurance. The health care organization then provides services to the patient. Documentation of the services furnished and the diagnosis associated with each service occurs during charge capture. Subsequently, during coding, the diagnosis and services are converted into alphanumeric or numeric codes in a claim, and are submitted to the third-party payor for reimbursement. After processing by the third-party payor using the appropriate methodology, the provider receives a remittance advice, adjusts its accounts, and makes its final settlement on the account with the patient. The next slides examine select aspects of the medical billing process and the revenue cycle. 11