Revenue cycle operations

There are three functional areas in the revenue cycle (improve revenue cycle): front end, middle, and back end.

FRONT-END PROCESSES• Pre-registration• Scheduling• Patient Access and Registration • Pre-authorization, Pre-certification, and Insurance Verification.• Point-of-Service Collections and Financial Counseling.

MIDDLE PROCESSES• Clinical Documentation/Medical Records.• Charge Capture and Coding.• Charge Master and Master Patient Index.• Late Charge Reductions.• Case Management.

BACK-END PROCESSES

• Billing: Primary and Secondary Insurance.• Reimbursement, Posting, Refunds, and Adjustments.• Follow-Up/Tracking.• Denial Management.• Bad Debt and Collections.• Customer Service: Front, Middle, and End Processes.• Management Expectations.

Quality measurements and metrics are important elements in the evaluation cycle, especially related to process improvement, for several reasons:

• Metrics support the analysis, recommendations, and conclusions—you cannot argue with quantifiable data.

• Metrics establish the tone where both negative and positive outcomes are measured.

• Metrics provide a mechanism for understanding outcomes and a way to obtain employee buy-in to change.

• Metrics establish accountability, especially for those employees not performing to par.

• Metrics provide data to leadership, enabling them to focus of issues, problems, and resolutions.

• Metrics are also used as a means to celebrate improvement once attained.