Essay on Interrelationship between the Revenue Cycle and Reimbursement

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The revenue cycle involves the functions that enable healthcare institutions to collect and manage income. The stakeholders of the cycle include care providers, patients, and insurers. Reimbursement is the process of paying for the services offered by institutions. Healthcare organizations obtain their revenue from the services that they offer to patients. They might gain revenue directly from the patients or from insurance bodies. The record keeping department of the healthcare sector has a critical role in the revenue cycle and reimbursement because it the records of patients served by organizations. These records help care insurers to reimburse the healthcare organizations. The revenue cycle and reimbursement involves front-end, middle, and back-end processes. During the front-end process, the patients register with insurers, and the providers authorize treatment. In the middle process, the medical facilities offer care to patients and records the procedure for reimbursement. The back-end process involves the confirmation and authorization of payment by the patient or the insurer. The departments that affect revenue and reimbursement process include the Revenue Cycle Management, communication, and record keeping.

The revenue cycle and reimbursement has improved the transparency of care bills. As such, patients know their medical bills and financial responsibilities in advance. However, providers experience challenges when collecting payments due to slow-paying individuals, inability to pay, and lack of accountability. Delayed or no payments hinder the ability of the providers to offer quality care to patients. Healthcare organizations should establish a system that enables them to keep the patients’ credit cards for automatic reimbursements after the calculation of care bills. The system will reduce time wastage that occurs when receiving disbursements from the patients. In addition, the providers can implement a hospital charge master to record the costs of each service, prescription, procedure, and diagnostic test, which can help to bill the patients or insurers. Healthcare organizations should maintain their charge masters to uphold the integrity of the revenue cycle. An inaccurate charge master can lead to issues such as compliance violations, underpayments, and overpayments.

Author: Patricia Leblanc