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Posted: September 17th, 2022
The Flow of the Revenue Cycle
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The Flow of the Revenue Cycle
The revenue cycle comprises of key processes that link the services provided by a healthcare provider with the procedures or methods by which the healthcare provider receives compensation for the services provided. The cycle incorporate patient intake, clinical services, capturing of the charges, billing the patient, and collection. Patient intake allows for patient identification upon intake into the facility. The next step constitutes the documentation of the services offered and recording of the charges, which produces medical records. Case management takes place during the documentation process and identifies patients with managed care and checks whether their insurance cover meets payer’s specific requisites. Then billing for the services, which is followed by the collection of cash. The provider sends the bill and awaits for payment within a specified period of time.
Medical Record and the Revenue Cycle
Successful revenue cycle management highly depends on the availability, robustness and accuracy of medical records. Medical records serve as the most effective means of documentation and proof of an event or services rendered. It is through medical records that patient charges are captured and recorded to facilitate the billing process of the revenue cycle.
Bill Hold
Bill hold refers to a situation where the hospital does not bill the patient immediately upon discharge. The patient is discharged and billed after some duration. For acute care the bill hold period is 3-5 days.
Case Mix Index (CMI)
Hospitals care about the CMI because it measures the mean severity level of procedures in a hospital. Hospitals are keen to identify the CMI since the Medicare and Medicaid services use it to determine the rate of reimbursement for hospitals across all cases. Having a higher CMI as a result of having higher costs due to complex cases leads to a higher reimbursement rate. CMI therefore serves as a unique tool to compare the performance of hospitals and directly relates to reimbursement.
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