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Revenue Cycle Management in Healthcare

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Analyze and describe about billing and coding in revenue cycle while answering these questions. What is meant by the term, "the revenue cycle"? What factors contribute to the complexity of the revenue cycle in health care? What are the six stages of the revenue cycle? Describe the registration process, including the activities that comprise it and how is it tied to the revenue cycle? Describe the two types of forms used for health services billing?

With properly cited references/APA format....

Thank you,

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Revenue cycle is not a term specific to the healthcare industry. Monitoring of revenue cycle should be a critical business focus of all industries. In the accounting profession, you often hear the saying, "Cash is king", which refers to the importance of cash flow in the ongoing sustainability of an organization. If you cannot pay your bills, you cannot stay in business, in the long run at least. That is what revenue cycle is about. One could argue that revenue cycle is the most important component of running any business, as it assures that a business is what is referred in the tax world as a "going concern".

"So this is the goal: To make money by increasing net profit, while simultaneously increasing return on investment, and simultaneously increasing cash flow." (Eliyahu M. Goldratt, "The Goal")

A high-level definition of revenue cycle across industries is the process of earning revenue for goods sold and/or services rendered, by employing methods that ensure a large percentage of monies earned are converted into liquid assets as quickly as possible. I felt it necessary to include the Goldratt quote above, even though he is referring to a manufacturing firm that makes "widgits", in contrast to a community healthcare facility, which is assigned the responsibility of caring for people. A manufacturing firm is concerned with optimizing production and general operations to maximize profits. A healthcare organization must find ways to best serve its patients, which often includes life and death scenarios. Although there are real differences here, there are also notable similarities. The most central being, they must both make enough money (profit) to keep the doors open. In addition, communities depend upon both of these types of organizations for their local economy, which includes bringing revenue into the community and job creation. Do not take business considerations out of administration of healthcare organizations. Caring for patients is the #1 priority, however, it is not enough. Careful planning and business acumen is essential to navigate the complicated business of healthcare and better guarantee that healthcare facilities will remain viable and available to serve their communities.

In healthcare specifically, revenue cycle is more complicated than other industries. There are several reasons for that. First, in healthcare there is always going to be the human factor. It cannot be discounted that this industry is dealing with the overall health and well-being of its "customers". Secondly, the amount of governmental mandates and regulations currently can be overwhelming, and the number and complexity of these regulations are only increasing over time. Some products of these regulations include, HIPAA, insurance reimbursement contracts, and complex coding requirements including ICD9/ICD10, DRG, and CPT. In fact, the conversion of ICD9 to the new ICD10 format is so complicated that its final release has been postponed by the government for several years in a row because providers (hospitals, physicians, clinics) are still trying to put technology, training, and processes in place to prepare for this change. Roper St. Francis, an 85 bed hospital, located in Mount Pleasant, South Carolina, gave a presentation at the 2015 Dixie Institute in Charleston, South Carolina. This presentation covered revenue cycle concepts, and focused on increases in ...

Solution Summary

Navigating the complex world of revenue cycle in the healthcare industry is examined.