Your basic introduction to comprehending the healthcare revenue cycle Life cycle of a medical bill this week.
It's more crucial than ever for everyone to comprehend how the medical billing process works, given the proliferation of high deductible health plans, the recent surge in telehealth appointments brought on by COVID-19, and many other factors at play. The healthcare revenue cycle affects everyone who receives healthcare, not just those who work in the industry.

The set of procedures surrounding healthcare payments, starting with the moment a patient schedules an appointment and ending with the payment of a provider, is known as the revenue cycle. Consider it in terms of the life cycle of a medical bill as one approach to frame it. Although this process can occur in a variety of ways, we'll outline a typical example below.

Pre-appointment
When a patient calls a physician to make an appointment, the revenue cycle for the majority of general care starts. Usually at this point, pertinent patient data will start to be gathered for the final bill, known as a claim on the financial side of healthcare.
If an insurance company's previous authorization is required for the appointment and procedure, the provider will decide at this time (referred to as the payer). The electronic health record (EHR) that was used to help create the claim also gets started at this point and will start to grow as the provider sends an eligibility enquiry to determine whether the patient has insurance.
Point of care 2.
When the patient shows up for their appointment, the process moves on to the following phase. This may occur when a patient shows up for a first appointment, an outpatient procedure, or a follow-up examination. An appointment for telemedicine may also be part of this.
The service provider may impose an upfront fee at any of these occasions. Another type of payment that fits into this category is a co-pay, which is the fixed amount patients pay after their deductible if they have insurance.
3. Making a claim
Following the point of care, the provider completes and sends a claim to the payer with the proper codes. Billing personnel must gather the required supporting documentation and attach it to the claim in order to achieve that.
The provider's team will keep track of whether a claim has been approved, denied, or rejected after submitting it to the payer. Managing the billing process accurately is not easy as providers might face hurdles in revenue cycle management. Moreover, Net Collection Rate below 95% shows that your practice is facing troubles in the billing process. To eliminate all these hurdles and maintain your NCR up to 96%, MedsIT Nexus Medical Coding Services are around the corner for you so that your practice does not have to face a loss.

Medical coding is the secretarial process of allocating reference numbers to each phase in the patient experience. Typically, the codes are based on medical records like a doctor's notes or lab results. These detail to a payer the diagnosis and rationale behind a patient's treatment. The payer uses this information to determine how much of an encounter is covered by a specific insurance plan and, consequently, how much the payer will pay.
4. Payment or refusal of insurance
When the payer receives the claim, they make sure it is accurate and matches the provider's and the patient's records. If a mistake is found, the claim will be automatically rejected, and the provider will need to submit a revised claim.
The adjudication process, which is a review process, is subsequently started by the payer. Payers review claims to ensure that the coding, documentation, medical necessity, authorisation, and other criteria are correct. The payer determines their financial obligation through this approach. The payer could reject the claim for any reason.
If the claim is accepted, the payer sends the provider their payment along with information outlining the specifics of their choice.
If the claim is rejected, the provider must decide whether to amend the original information or whether it makes more sense to challenge the payer's ruling.
The payer will provide the patient an explanation of benefits (EOB) following adjudication. This EOB will detail how the patient's insurance compared to the costs associated with their care. Although it is not a billing statement, it does include information on the amount the provider charged the payer, the percentage that insurance would cover, and the patient's share of the cost.
5. Payment to patients
The next step is when the provider gives the patient a statement outlining their share of the cost. Once the provider and payer have reached an understanding regarding the specifics of the claim, what has been paid, and what is still owed, this step begins.
When a patient makes the payment that they owe the provider for their care, the process is complete. The patient may be able to pay the full amount at once, or they may need to work with the physician to establish a payment schedule, depending on the amount.

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The summary
Only one possible scenario for a medical bill is illustrated in the example above. Frequently, steps are added or repeated. There isn't always a clear path from patient care to full payment due to the complexity of healthcare payments and the parties involved. It is called the revenue cycle for this reason.
Healthcare payment simplification and unification are goals of Waystar. Many of the above-described steps in the billing process are automated by our technology, saving providers and their teams time and effort while improving patient transparency. Find out more about how the Waystar platform improves operations and automates manual chores. The revenue cycle can be optimised so that providers can concentrate their efforts on enhancing patient care. And everyone can move forward more effectively that way.