Revenue Cycle In Health Care Essay
Taking care of the sick has turned into a lucrative business. Healthcare must effectively manage and maximize their revenues. To accomplish that, there must be a revenue cycle in place. The revenue cycle consists of six stages and as follows: Provide services, document services, establish charges, prepare claim/bill, submit claim, receive payment. (Cleverley, Song, Cleverley, 2011, pg. 15). For healthcare providers, accomplishing the stages brings a significant degree of difficulty.
The factors that contribute to the difficulty of the revenue cycle in health care includes the nature and importance of the services provided. Documentation and billing can also be affected by the regulation factors. Different payment systems being utilized by multiple payers complicates the healthcare firms’ revenue cycles. (Cleverley, Song, Cleverley, 2011, pg. 14). With the stages of the revenue cycle, additional details
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Medical information is gathered and stored in a medical record for documentation purposes which is needed at the time for billing to the payer. Medical Records contain information required by The Health Insurance Portability and Accountability Act (HIPAA) of 1996. HIPAA requires “two categories of information be reported to payers: diagnosis codes and procedure codes”. (Cleverley, Song, Cleverley, 2011, pg. 17). There are two coding systems used to provide the required codes: International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and Healthcare Common Procedure Coding System (HCPCS). Diagnosis codes consists of three digits initially, and if necessary followed by a decimal point and one or two additional digits. Example: 122.25. Procedure codes are used when a service is provided such as surgery and have up to four digits. HCPCS codes are used for reporting both inpatient and outpatient procedures by physicians. (Cleverley, Song, Cleverley, 2011, pg.
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