Blog

What Is Coding and Revenue Cycle Management?

 At the core of the healthcare industry, doctors, nurses, and clinical personnel are at the front lines when it comes to treating patients, and saving lives. But, without revenue management, these hospitals and healthcare facilities would not be able to operate. That’s where Coding and Revenue Cycle Management comes in.

Coding and Revenue Cycle Management is the process that facilities use to manage the administrative and financial functions associated with patient registration, benefit verification, coding, claims processing, and payment and collection, all integral aspects of revenue generation. The Coding and Revenue Cycle Management process, encompasses all the  elements that complete the “cycle” of the patient visit, making it a versatile career choice.

The key elements that make up the Coding and Revenue Cycle field include:

  • Patient Pre-authorization Before a patient is seen they must go through pre-authorization process where insurance providers determine whether they will cover a medication, service, or procedure.
     
  • Insurance Eligibility and Verification Medical office software can include automatic checking of patient eligibility via the Internet over secure channels. Using dedicated Revenue Cycle Management software can speed up the process in verifying if a patient is entitled to a particular benefit. Revenue cycle management personnel are always at the forefront of this. 
     
  • Charge and Code
    Coding is at the heart of physician reimbursement, hospital payments, quality review, benchmarking measurement and the collection of general medical statistical data. Coding the patient visit properly and in compliance with the individual payer requirements makes this element key to successful generation of revenue.
     
  • Claim Filing and Submission
    The submission of claims is the vital stage in the overall process because the reimbursement directly depends on it being done properly. Coding and revenue cycle management personnel  help ensure the payer reimburses in a timely manner and any potential errors are resolved quickly and efficiently.
     
  • Denial Management

In the case where a claim is rejected, the revenue cycle management professional steps in and resolves the errors and ensures that the claim is scrubbed for coding errors and resubmitted in a timely manner.

  • Collections 

When there is reduced reimbursement from the payers meaning the health plan did not cover all the services. It is the duty of a Revenue cycle professional; to follow up with the Insurance Company, make adjustments as needed or document the errors for future consideration when billing.

The role revenue cycle staff and managers is undeniable.  The revenue cycle process ensures that hospitals and clinics receive proper payment for services to keep facilities running smoothly and always prepared to receive new patients.

To learn more about our Coding and Revenue Cycle Management Associate’s Degree Program, visit our website for more information. The program is up to 96 weeks and we accept transfer credits!