Speaker 1: Hey, my name is Jasmine Villaliz and I'm with IPS Learning Institute. We help alleviate the stress and confusion on the business side of healthcare. Today, we are talking about the healthcare revenue cycle. What exactly is it in a nutshell? I've heard from many of you, you want the short and sweet version. So here it is guys, the healthcare revenue cycle. All right, what is the healthcare revenue cycle? In a nutshell, the healthcare revenue cycle is the way that money moves through any healthcare organization or medical practice. So from the time the services or charges are generated at the patient visit till the payment of those services has been received. And so we're gonna go through each stage of the healthcare revenue cycle. The healthcare revenue cycle starts with either a physician ordering or a patient self-referring. So the patient might send themselves to a practice, maybe calling after searching for that provider online and deciding they want to schedule if they have a plan that allows them to go wherever they would like, they can be able to self-refer. The next thing that happens is either intake or a patient might pre-register. So they might call to make an appointment and do a pre-registration process. The next thing that happens is the meat of the healthcare revenue cycle. The patient's visit. So the patient comes into the office, sees the provider and the provider of service will generate diagnosis codes and procedure codes. Those things will be the birth of our claim. Those two things together will be the birth of our claim that allows for the money to then be generated through the rest of the revenue cycle. So after the provider has selected their diagnosis and procedure codes, in some cases, there might be an intervention of a medical coder at this stage and or there may be a use of a software to just scrub the procedure codes to ensure accuracy or that they're still compliant. So billing and claim submission is next. So claim has been created, that we've double-checked what's on our claim and then we sent the claim out the door to an insurance company. Next, the insurance company receives the claim and either kicks it out or they accept it for what we call adjudication. So adjudication, I will link a video above when we talked about adjudication. It's a big word and it just means the insurance company process the claims. Either the claim is paid or it is denied at that time. We receive that information, we post the payments at the practice level and reconcile the patient's account. And if there's any denials, we then process, capture those denials and hopefully work through those methodically to try to recover payment for the denied services. If there's no denial and there are some claims that are still outstanding, that process is called the accounts receivable process or the AR. So we work the accounts receivable at this stage. Once claims have been paid by an insurance company, as much as expected, the remaining amount then may be billed to a patient. Patient is billed at whatever frequency or the number of statements that are issued by a practice or communicated about their balance by that practice. Then the patient may be sent to collections if the balance is still outstanding. That typically is an outside function through an outside agency that follows through the collection process until payment is zero. That wraps up the money portion of our revenue cycle. Then we layer on this process we call the audit process, which connects to each layer of our revenue cycle for us to ensure that we are working as efficiently and compliantly as possible. So that is our healthcare revenue cycle. I hope you liked that quick nutshell version. If you want more, we have a full series where we cover every single level of the healthcare revenue cycle in grave detail. I will link that above in the card and below in the description. Thanks for watching. If you found this video helpful, give it a thumbs up. And if you're new here, consider subscribing so that you don't miss out on the videos we post each and every week to help strengthen your understanding on the business side of healthcare. We post videos weekly and we go live on a regular basis. So until next time, my friends. Bye. Bye. Bye.