CHAPTER 24
Revenue Cycle Management and Partnership
Sybil Yeaman
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UNDERSTANDING THE REVENUE CYCLE, controlling its increasing complexity, and choosing the right revenue cycle management partner are critical for the financial stability of every urgent care center. Although the right location and viable health-care contracts are vital for success, systematic clinical and financial oversight of the revenue process and disciplined revenue cycle management ensure continuous cash flow for operating the center.
An urgent care center is a very complex and constantly changing combination of health-care information, medical documentation, and billing and claims services. A clearly defined and efficient workflow of patient information and documentation will make the reimbursement difference between a successful business and a center on the edge of insolvency.
The revenue cycle (Figure 1) begins when a patient enters the urgent care center for medical care and ends when all medical services and diagnostics tests are paid for. The urgent care center bears complete financial responsibility up front for all medical services that patients receive during their physical exam and treatment. This financial commitment for equipment, staff, supplies, and diagnostic testing is expensive. The financial risk is high, and the responsibility to meet regulatory requirements is intense. Controlling the revenue cycle, from patient registration to payment, is critical for the financial stability and growth of the center. How you manage your patient information, operations workflow, and billing will determine your level of success in managing your center’s revenue cycle process.
Figure 1. The revenue cycle.
Successful management of the revenue cycle process for your urgent care center and for your revenue cycle management partner, if you outsource the management function, requires development of a detailed operational process and protocols to be strictly followed in the following areas:
Patient registration
Medical services and documentation
Coding, billing, and collections
Revenue analytics and management