Speaker 1: Hey y'all, I'm Courtney Sharae. Welcome to my channel. My channel is all about career, lifestyle, and a little bit of fashion. If you're new here, hey, make sure to hit that subscribe button before you leave. And to all of my returning subscribers, hey y'all, hey, how y'all doing? I'm doing good. Thanks for asking. Guys, guess what? Today we're talking about revenue cycle management and revenue cycle management is my favorite career in healthcare administration. Y'all, I absolutely love revenue cycle management. This will be a two-part series. In the first part of the series, I will talk about the revenue cycle management process. And in the second part of the series, I will share with you careers in revenue cycle management. All right, y'all ready to get started? Revenue cycle management is the process used in healthcare to track the collection of payments for the rendering of health services from the scheduling of the patient's initial appointment with a provider. And it ends when all payments have been collected from patients as well as third-party payers. You know how I always tell y'all there are many career sectors in healthcare administration? Well, revenue cycle management is actually categorized under health information management, which is a career field within healthcare administration. Got it? Good. If you don't got it, make sure to go and check out my video titled seven entry-level healthcare administration careers, where I break down the healthcare administration career sectors. And to learn more about health information management, go and check out my video titled four non-clinical healthcare administration jobs. Both of the videos will be linked below in the description box. All right, y'all, let's go ahead and take a look at this five-step revenue cycle process. But before we jump in, let me say this. There are some people who will say that there are seven steps in this process, nine steps, or even 13 steps. But regardless of how many steps are in the process, the beginning, middle, and the end are exactly the same. Okay? The first step in the process is the start of a claim. Healthcare revenue cycle management starts when a patient schedules an appointment to seek medical services. When a patient schedules an appointment, they have to go through patient registration. Patient registration is when a patient's demographics is entered into the electronic health record system. If the patient has health insurance, their insurance eligibility and benefits are verified. Eligibility and benefits allows the provider to know what types of services are covered under the patient's insurance plan. This information also includes the patient's copayment, coinsurance, and deductible amount. Once the patient has been registered and their insurance and eligibility has been verified, they can now go ahead and get their appointment scheduled. Step two, claim submission. The claim submission process begins after services have been rendered. The provider has already completed their notes, and now it's time for the encounter to be coded. During the claim submission process, medical coders translate the medical notes into current procedural terminology, or CPT codes. In addition to CPT coding, medical coders also go through to double check that all of the international classification of disease codes or ICD-10 codes are there. Each CPT code has a set fee or charge amount. Charge entry is when a CPT code, along with its charges, is added to a patient's account. The final step in the claim submission process is timely filing. It is imperative for claims to be filed to third-party payers within a timely manner, because third-party payers have something that is called a timely filing limit. The timely filing limit count starts on the day of service, and it ends after a period set forth by the third-party payer. For example, UnitedHealthcare has a 90-day timely filing limit after the date of service. So if you were to file a claim on the 91st day after the date of service, that claim is going to get denied for timely filing. Denied. The next step in the process is claims management. After the claim has been adjudicated and processed by the insurance company, the provider will receive an electronic remittance advice, aka an explanation of remittance, aka an explanation of reimbursement, aka a remittance advice. Like you can literally use all of those interchangeably. You just can. An explanation of remittance is an itemized statement that shows the allowable amount for each CPT code billed to that insurance company, the adjustment amount, the adjustment reason, the patient responsibility. So if the patient has coinsurance, copayment, deductible, it shows that amount. It also shows any denials and denial reasons. After the remittance advice is received, it is now time to post payments. Payment posting in healthcare is a little more complex because everything associated with that payment that you saw on the remittance advice must be captured in payment posting. Now that your payments are posted, you're going to take a look at the denials because that is also going to be listed on that remittance advice. You're going to see exactly which CPT codes were denied and what the reason was. And from there, you're going to go ahead and correct those issues. So it may be a modifier, it may be a CPT code, it may be that the diagnosis code isn't appended properly. Like there are so many reasons that procedures or claims as a whole deny. And once you update the claim with the proper information, then you want to go ahead and appeal that claim. Step four, accounts receivable management or AR management. AR management sounds so much better than accounts receivable management. AR management. So in this step, it's all about the money, honey, okay? We are trying to get all of the money in the door. That's going to be from the patient, the insurance company. We're just trying to bring the money in, okay? So if the patient responsibility was not collected upfront at the time of service, now you got to send statements to the patients to let them know like, hey, Mr. Smith, you have a balance of $50 and this is your co-payment. And now you want Mr. Smith to pay as expeditiously as possible. AR follow up with third party payers is also done in this part of the process. Typically payers pay within 14 to 31 days after the claim has been submitted to them. And that's usually via electronic funds transfer. If you haven't received payment within 14 to 30 days after the claim has been filed with the insurance company, you're going to go ahead and do AR follow up to get your coins, okay? That's what you just got to do. Working towards recovering monies from delinquent accounts is also a part of AR management. And the fifth step of the revenue cycle management process is analytics. Analytics is where inefficiencies in the revenue cycle management process can be identified. For example, if you've noticed that there has been an increase in denials from a specific payer, you can go in and analyze the data. You can break it down to denial by CPT code, denial by provider, so on and so forth, so that you can data mine, figure out exactly where the issue is, why you're getting those denials. And once you have done your analysis, you can then take action on it. You can make changes to your coding. You can make some changes to your revenue cycle management process. Whatever it is, you can go ahead and use that data that you have analyzed and make proper changes so that you can resolve the issue and decrease those denials. And that's the end of the revenue cycle process, y'all. Keep in mind, this process is done for every single patient. Every single patient. It's important for healthcare organizations to have a solid revenue cycle management process because it's an efficient system that when done properly, enhances revenue performance. Thank you all so much for watching. Thank you so much for your love and support over these last six months that I've been doing YouTube. I appreciate each and every one of you so much. Don't forget, part two to this video will be uploaded in August. If you haven't done so already, go ahead, like, comment, subscribe, and hit that bell notification so that you can be notified every time I upload a new video. And so you'd be notified when part two is uploaded. All right, y'all. That's all I have for you today. I look forward to seeing y'all in the next video. Peace.