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Revenue Cycle Management for Healthcare Providers

Posted September 9th, 2016

Revenue Cycle Management refers to the extensive and complicated process to yield a payment for a service provided by a healthcare provider. Healthcare poses a confusing and challenging revenue cycle that dramatically differs from any other industry. From the minute the patient contacts a healthcare organization until after the payment is received, healthcare organizations have to meet a dizzying array of requirements to properly qualify the patient’s insurance coverage, meet the service and documentation requirements, and build a claim that properly and accurately qualifies the service, patient situation, complicating factors, and condition.


Unfortunately, the healthcare revenue cycle is getting more complicated due to the search for improved productivity and lower costs without sacrificing patient care. The connection between services and payments is becoming more obscure. Indeed, many new payment mechanisms are not directly tied to specific services and pose a revenue cycle and control challenge to all healthcare organizations.

The 2017 Smart Decision Guide to Revenue Cycle Management, which is currently in development, will address the challenge of dealing with and managing dramatic changes to healthcare revenue cycle management during the transition from the fee for service model to a hybrid model. The evolving revenue cycle challenge includes fee for service components, but requires new management tools to assure that your practice or healthcare organization qualifies for other payments and incentives and/or manages your obligations under a variety of other payment mechanisms.

Whether as a healthcare provider you are looking for new tools or adjusting your use of existing medical billing and electronic health record systems, this guide will help you understand the challenges and opportunities of the evolution of healthcare revenue cycle management as well as what you need to do to manage patient service and maximize your revenue.