Consultant Corner Podcast

A Quick Breakdown of the Healthcare Revenue Cycle Process

By Stoltenberg Consulting

Thank you for visiting the Consultant Corner. Listen to our first episode uploaded as a short explainer video above. Then view the transcript below to see Joncé Smith's, Vice President of Revenue Cycle Management, high-level explanation of the three phases of the healthcare revenue cycle process across the patient care journey.

Revenue Cycle Early Phase

Joncé: "When you call your doctor and want an appointment, that's early phase. When you show up and fill out pages [of patient information] that you've already filled out, that's the onboarding portion of the early phase. So everything from the time you pick up the phone and say, ‘I think I've got the flu,' to Dr. Smith seeing you in his office — that's early phase [of the revenue cycle]."

Revenue Cycle Mid Phase

Joncé: "Then mid phase is when you've been seen, and charges are generated. Now, I've got somebody to read the clinical chart and code it, so the charge goes through to a claim that then goes to your insurance to get paid. That's mid phase."

Revenue Cycle Late Phase

Joncé: "Late phase is everything from once the insurance gets it. They decide if they're going to pay it or not, how much they're going to pay, along with how much is to your deductible. Then, insurance pays (let's say) 40% of the bill. Well there's a remainder after that, which will come to you that you have to pay. Maybe it's your deductible. Maybe your deductible has been met, but your insurance only covers 80% of the cost. Then when that comes to you, it's called a guarantor account. Guarantor accounts are paid, or they go to bad debt. Once they go to bad debt, that's a whole other cycle."

Joncé: "Everything from you pick up the phone to your account goes to zero — that's the revenue cycle."

To submit a RCM question, email us at stoltenberg@stoltenberg.com, and stay tuned for future health IT insight from the Consultant Corner.