R1 RCM: Healthcare Revenue Cycle Management Overview
Former AVP at Ensemble Health Partners
inpractise.com/articles/r1-rcm-healthcare-revenue-cycle-management-overview
Former AVP at Ensemble Health Partners
Interview Transcript
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Could you clarify what you mean by operation and client relationship management?
The revenue cycle is typically divided into three parts. There's the front end, so that's all the processes that occur prior to the patient receiving service. There's the middle revenue cycle, which is where the health information management or the medical records team takes over. This is where they read the clinical documentation that is placed into the record by the provider. They translate that information into alphanumeric codes that are placed onto the bill. And that is how you communicate with the payer about the diagnoses associated with the patient and the procedures that were rendered
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Could you clarify what you mean by operation and client relationship management?
After that, the bill is created and sent electronically to the payer, which initiates the back end of the revenue cycle. Once the bill is sent, it is either paid or denied. Paid claims are assessed to ensure they're paid accurately per the payer contract, while denied claims are worked on. The reason for the denial could be technical or administrative in nature, such as a missing field on a bill, or there can be clinical denials where the provider is asked to provide medical record information for the payer to review.
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Could you clarify what you mean by operation and client relationship management?
There's also the denial management, the cash posting function, and sometimes accounts end up with credit balances, so there's the credit balance process. Finally, there's the bad debt, where accounts are unfortunately turned over to bad debt agencies for collections. That's the back end. When I say I'm responsible for all of operations, it includes all these areas.
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