Mastering the Healthcare Revenue Cycle Flowchart

How mastering the Healthcare Revenue Cycle Flowchart can improve the patient financial experience

Healthcare revenue cycle management is more challenging than ever for providers. Healthcare staff has shouldered the burden of the COVID-19 pandemic for the past two years. Patient needs and expectations are constantly evolving. Innovations in technology can improve the patient financial experience and increase cash flow for the provider. But, many providers don’t know where to start or have concerns about the time and resources it will take to implement such a huge change.

As a leader in the patient payment industry for over 20 years, HealthPay24 understands that adopting the right steps and committing to follow them can boost profitability and increase the bottom line for hospitals and health systems. As a resource to providers, we have created this 8-step healthcare revenue cycle flowchart to offer insight and a better understanding of healthcare processes and best practices. 

Healthcare revenue cycle management

Healthcare revenue cycle management is the driving force behind a hospital or other healthcare provider. A healthcare provider cannot serve patients without being financially healthy. Each step necessary to secure payment for services rendered—from the patient first calling to inquire about making an appointment, to submitting a claim and receiving reimbursement—is outlined in the healthcare revenue cycle flowchart below. 

A successful revenue cycle does more than bring money in the door for the hospital; it improves the patient financial experience by seeking to answer the question all patients have when they receive medical services—how much will this cost? Inefficiencies in the revenue cycle or mistakes with the insurance claim can wreck a patient’s financial experience with a given provider, causing them to look elsewhere for their medical care. Accuracy and competence are crucial at every step of the healthcare revenue cycle.   

The first step begins with the patient.

1. Patient schedules appointment

The patient schedules an appointment for a medical service or routine appointment either through an online portal, in-person with the healthcare provider or by calling the scheduling team. Staff, or the website if registering online, should be easily accessible. This is the patient’s first glimpse into the relationship they can expect with a provider, and making an excellent first impression is key.

2. Staff verifies insurance

Insurance eligibility verification is a critical step for healthcare revenue cycle management. The plan coverage and benefits of the patient’s insurance must be carefully verified by a staff member. Making a mistake during this process could cost the provider the patient’s trust.

To provide excellent customer service, staff should offer the patient an estimate of the cost of services after verifying the insurance. This estimate is not a guarantee—the provider may find additional procedures to be necessary, for example—but the patient can proceed with the visit knowing roughly what they’ll be expected to pay. 

Patients ask increasingly frequently about the costs of their healthcare. By helping patients understand what their care costs and what portion of that they will be expected to pay, staff will improve the patient financial experience and decrease the strain of relying on collections to collect payments down the road. 

3. Patient offered pre-pay option

After an estimate is provided to the patient, staff can offer the opportunity to make a payment toward the estimate calculated, or pre-pay the balance in full. This is convenient for the patient and the provider. The patient doesn’t accrue another bill to worry about, and the provider can proceed with the next step in the healthcare revenue cycle. Educating the patient about how and where to pay can help ensure the provider receives payment. A convenient payment platform where a patient can use their mobile wallet will appeal to many.

HealthPay24 is the only patient payment platform allowing providers to take payment off the estimation and reconcile it immediately with accounts receivable. Providers and patients can see the payment in real-time.

4. Medical records management

The provider will perform the necessary medical procedures on the patient. After this, the records are sent to the billing team. Thorough records are critical for the healthcare revenue cycle. Every aspect of care must be captured in the records to file an insurance claim. If the visit is not properly recorded, the provider risks not being paid for the services provided. 

5. Medical billing

After the medical billing team receives the records from the provider, they will verify them for accuracy and note the medical codes used representing the procedures performed. Claim denials are on the rise, but a highly-trained medical billing team and software that automates coding can help make sure the claim is accepted. The medical billing team will prepare the claim for the insurance company regarding the conditions outlined in the patient’s insurance policy.   

6. Insurance claim is filed

The medical billing team will carefully review the claim and submit it to the insurance company. This should be done promptly. The claim could be denied if it’s not filed correctly, quickly, and completely, resulting in the provider not being paid for the care given to the patient. 

7. Payer contract management

The insurance company will analyze the claim. This can take a while. The medical billing team will follow up regarding the payer contract. The claim will either be accepted, denied based on errors, or rejected. 

8. Payments processed

The final step in the healthcare revenue cycle flowchart is to collect any remaining balance from the patient and/or insurance. If a refund is owed to either the patient or payer for an overpayment, this must be completed as well.

Hopefully, as mentioned above, the staff has already formed a relationship with the patient and the patient understands their responsibility and how they can make payments. Treating patients with respect, providing excellent customer service, and being transparent about the cost of care will make a patient more likely to send a prompt payment. 

Post-service communication should continue to cultivate this relationship as it aims to receive payment. An omnichannel payment strategy contains multiple payment methods for a wide patient base, especially cashless and paperless methods preferred by many modern patients. If payment is not made on the outstanding balance, the bill will be sent to collections in an attempt to secure the payment. 

healthcare revenue cycle flowchart

Using a healthcare revenue cycle flowchart

A healthcare revenue cycle flowchart is a practical tool for understanding the healthcare revenue cycle. Whether a hospital or an urgent care center, visualizing each step of the healthcare revenue cycle management, one can see where to designate more resources to increase profitability and maintain a successful business. 

A smooth and error-free revenue cycle leads to a smooth patient financial experience. A smooth patient financial experience leads to a loyal patient and one who shares their positive financial experience with others. Automating as much of the revenue cycle as possible avoids mistakes and simplifies the payment process for everyone. But, warm and well-trained staff are crucial to supporting a patient on their medical journey and helping them to feel comfortable. 

Offering innovative technology alongside incredible customer service will make patients want to receive medical care from your facility. 

If this resource has helped you, visit us at HealthPay24.com to see how our patient payment platform can help benefit your revenue cycle and improve patient collections!