Defined by the Healthcare Financial Management Association (HFMA), the revenue cycle is “all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue.”
Put simply, it’s the steps taken to get paid for physical therapy services.
The revenue cycle is a complex series of steps, pathways, and workflows which involves numerous persons within and outside of the clinic. From the front office to the treatment room, to the back office, insurance company and more, managing the revenue cycle is no easy task.
But we try to make things easy around here, so we’ve broken the revenue cycle into three easy-to-understand steps to help create a foundation for what is occurring, and when, in your pursuit of payment for physical therapy services.
The steps are: (1) pre-visit processing, (2) visit-processing, and (3) post-visit processing. Each of these steps consists of a multitude of sub-steps which must be understood and followed in order for the revenue cycle to run smoothly.
Step 1: Pre-visit processing
Pre-visit processing is arguably the most important. It is at this step in which critical information is gathered and verified prior to care taking place. If during this step any required information is not able to be obtained or verified, continuation of care may result in non-payment.
Pre-visit processing includes the following sub-steps:
- Patient registration and scheduling
- Insurance verification and pre-authorization
- Patient out-of-pocket estimation
- Collection of existing patient balances due
Step 2: Visit processing
Visit processing is the part that everyone remembers. It’s where we meet the patient, care is performed and translated into codified data which is communicated downstream between your practice and payers.
Visit processing includes the following sub-steps:
- Scanning of identification and insurance cards
- Verification of demographic and insurance information
- Obtaining necessary patient consents
- Collecting co-payment, co-insurance, or deductible amounts due
- Providing the patient care
Step 3: Post-visit processing
After the visit, there’s a lot of work to do for every encounter. It is during this step that the claim is born and coordination becomes key between the practice and payers with regard to payment for services performed. Depending on the payer, post-visit processing can take from days to several weeks to fully adjudicate submitted claims.
- Charge capture and coding
- Charge submission and claim creation
- Claims editing (if necessary)
- Payment posting
- Insurance denial management
- Credit and refund processing
- Patient follow-up and collection
- Patient customer service
By understanding and executing the steps above, the revenue cycle becomes less of a matrix and more of a step-by-step process which can be managed across numerous persons or departments. If you have questions about how Vantage Therapy Billing can help you manage your revenue cycle, contact us today to learn more.