A properly functioning  revenue cycle gets the money you have earned as a provider of health care from third party payers and patients on time, with no hassles.  The process of collecting money for services rendered involves many steps, each of which has there own pitfalls.  The revenue cycle encompasses many different systems within a health care system.  Codebusters brings revenue cycle experts who can deftly handle the day to day challenges of navigating the health care reimbursement system.

Revenue Cycle Process

It begins with the patient.  Each patient’s ability to pay must be assessed prior to the provision services.  This is of course not always possible, nor is it always possible to deny care due to inability to pay.  Once a diagnosis is determined, the physician must ensure that the procedures and tests required are justified by the hospital care management rules and the payer guidelines.  Of course, the physician documentation needs to be able to clearly explain why a patient sought treatment and what reimbursable services were provided.  From here the coders assign the diagnosis and procedure codes.  Other codes are assigned to the claim by the computer system through the Chargemaster, an area of much growth.  Once the patient has been discharged, the claim is then submitted by the billing department who verifies that the claim meets the specific payer requirements.  Of course providers need a denial management process and a collections division.  Each step of the process is dependent on the one before it.  Codebusters can help provide the personnel who know how to manage the complexities of the revenue cycle.