Healthcare Revenue Cycle is a highly complex process that involves every team member within the organization. With continuous oversight and training your reimbursement ratios can improve. These slides depict a general and high level overview of the functions of the cycle process.

1. Revenue Cycle from Beginning to End
Created by Laura Murdock, CPPM, CMPE, SHRM-SCP, WCCP, SIP, CPC
This Photo by Unknown Author is licensed under CC BY

2. Front: Patient Access
Middle: Charges & Payer Integrity
End: Billing and Collections Services
Created by Laura Murdock, CPPM, CMPE, SHRM-SCP, WCCP, SIP, CPC

3. Front
•Scheduling and Registration
•Verification/Authorization/Patient Financial Clearance
•Medical Necessity
•Collecting Co-Payments, Deductibles, and Co-Insurance at the time of service
•Alerting patients if they have an outstanding balance
Middle
•Charge Capture
•Payer Credentialing
•Coding and Billing Compliance
•Payer Strategy & Negotiations
•Payer Contract Reviews
Back
•Claims Processing
•Remittance
•Payment Posting
•Statement Submission
•Denial Management
•Data Analytics
Created by Laura Murdock, CPPM, CMPE, SHRM-SCP, WCCP, SIP, CPC

4. FRONT END BILLING FUNCTIONS
Verifications of insurance coverage
Proper and informative dialogue with patient
Preauthorization verifications
Proper clinical documentation
Collecting Co-Payments, Deductibles, and Co-Insurance at
the time of service
Financial counseling
Created by Laura Murdock, CPPM, CMPE, SHRM-SCP, WCCP, SIP, CPC

5. MIDDLE BILLING FUNCTIONS
This should always be an ongoing process
 Credential all providers with insurance companies
 Review the provider coding (i.e. E/M service, psychotherapy,
interactive procedure)
 Ensure the providers are submitting notes on a daily basis
 Review EOB’s for reimbursement trends
 Compare contracts with reimbursements
Created by Laura Murdock, CPPM, CMPE, SHRM-SCP, WCCP, SIP, CPC

6. BACK END BILLING FUNCTIONS
 Processing all claims in a timely manner (i.e. daily)
 Reviewing all remittance advices/EOB’s
 Timely posting of all payments (daily)
 Reviewing all denials
 Statement submissions
 Payment variant analysis
 Denial posting and resolution
 Hold insurance companies accountable by reviewing
reimbursement trends
 Reporting results and analysis to upper management
Created by Laura Murdock, CPPM, CMPE, SHRM-SCP, WCCP, SIP, CPC

7.  Training and Performance Management
 Compliance
 Leveraging Technology
 Data Analysis
Created by Laura Murdock, CPPM, CMPE, SHRM-SCP, WCCP, SIP, CPC