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Topic

Revenue Cycle Management

10 articles on revenue cycle management — what the work involves, what to organize before handing it to anybody, and how to tell whether it is working. No gates and no email capture.

  • How eligibility verification actually works

    Most of what a practice loses to coverage problems is decided before the patient arrives. This is what a dedicated eligibility seat checks, when it checks it, and how to set the queue up so the front desk stops finding out at the counter.

    Eligibility 7 min read

  • How prior authorization works, start to finish

    Authorization work fails in the gap between submitting and deciding. This is how to staff the chase, what to record, and how to stop authorizations expiring quietly before the service is rendered.

    Prior authorization 6 min read

  • How denial management works, and what it costs to skip

    Reworking denials one at a time is labour. Classifying them is the part that stops next month’s. This is how to run a denial queue that does both, and what to define before handing it to anybody.

    Denials 7 min read

  • How payment posting works, and where money hides

    Payment posting decides what every other report in the practice says. Posted carelessly, it hides denials inside adjustments and makes the ageing report fiction. This is how to run it properly.

    Revenue cycle 6 min read

  • How charge entry and claim submission work

    Charge lag is the cheapest problem in the revenue cycle to fix and the least often measured. This is how a dedicated charge entry seat runs, what it should scrub before submission, and what has to be decided first.

    Revenue cycle 6 min read

  • How medical coding works in a practice

    Coding is the one back-office function where being fast and wrong is worse than being slow. This is how to set up an outsourced coding seat so the record leads and the query process actually works.

    Operations 5 min read

  • How provider credentialing works, and what stalls it

    Credentialing is administratively simple and operationally brutal, because everything depends on dates nobody is watching. This is how to staff the chase and keep a calendar that prevents the expensive version.

    Credentialing 4 min read

  • How hospital patient access and pre-registration work

    Registration is where most denials are created and where almost none are detected. This is what pre-registration and financial clearance should cover, and how to staff it as a defined queue.

    Revenue cycle 4 min read

  • How to find payer underpayments nobody is looking for

    A denial announces itself. An underpayment does not — it looks exactly like a payment. This is how to build the comparison that finds them and the evidence that recovers them.

    Revenue cycle 4 min read

  • How chronic care management and RPM billing work

    These programmes are administratively heavy and clinically light, which is why they stall. This is what the administrative layer has to do for the clinical work to be billable.

    Operations 4 min read

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If this is work somebody on your team is doing at four in the afternoon, it can be a seat.

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