The Healthcare Financial Management Association (HFMA) describes the revenue cycle as “all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue.” In other words, it’s the steps that are taken to receive payment for physical therapy services.
There is a number of working factors and considerations that come into play when looking at the steps that must be in place to get paid. To make things easier to understand, take a look at these steps that can help build a revenue cycle management foundation for what is occurring, and when, in your pursuit of payment for your services.
Step 1: Pre-Visit Processing
This is perhaps the most important step, as it is where critical information is gathered and checked prior to providing patient care. If necessary information is not provided during this time, then continuation of care may lead to non-payment.
Pre-visit processing typically includes evaluating the following:
- Patient registration and scheduling
- Insurance verification and pre-authorization
- Patient out-of-pocket estimation
- Collection of existing patient balances due
Step 2: Visit Processing
The second step of the process is where we actually interact with the patient, provide care, and then translate that into codified data that can be communicated between your practice and payers.
Visit processing includes completing the following:
- Scanning of identification and insurance cards
- Verification of demographic and insurance information
- Getting patient consents
- Collecting co-payment, co-insurance, or deductible amounts due
- Providing the patient care
Step 3: Post-Visit Processing
When a patient has finished seeing you, different paperwork must be filed. This is where the claim comes in and a good amount of coordination must take place between the practice and payers in order to decide on payment for services performed. Post-visit processing can range from days to weeks to fully adjudicate submitted claims.
Post-visit processing may require the following:
- Charge capture and coding
- Charge submission and claim creation
- Claims editing (if necessary)
- Payment posting
- Insurance denial management
- Credit and refund processing
- Patient follow-up and collection
- Patient customer service
With this step-by-step process, you’ll hopefully have a better idea about the framework that goes in to receiving payment for your services performed.