I enter any reporting assignment that hits on health care finance with a certain amount of trepidation. The revenue cycle in this industry defies description. There are dozens of steps from the time service is rendered to the day—often weeks later—when the reimbursement check hits the provider’s bank account. Merely understanding Medicare and other health plan payment rules can chew up vast resources before a claim even leaves the building. Then once it does, there are the ever present intermediaries—the claims clearinghouses. And getting payers to talk about what happens to claims once they hit their front door is not easy. Rare indeed is the source who can lay claim to understanding the entire revenue cycle process (where no two paths seem to be the same).
But I do know this much: health care organizations are facing financial challenges unlike any they have seen before. It’s in part fueled by the recession and the rise in uninsured. For many, more people are showing up for services with little or no ability to pay. The tightening financial picture begs for easy-to-use tools for administrators to understand how their departments are faring in the grand scheme of things. These managers may not see the entire revenue cycle, but they do understand their role in it.
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