The document outlines the comprehensive revenue cycle management process, categorized into three phases: front-end (patient access), middle (charges and payer integrity), and back-end (billing and collections). Each phase includes detailed functions such as scheduling, insurance verification, charge capture, claims processing, and denial management, emphasizing the need for ongoing processes and timely actions. It also highlights the importance of compliance, technology leverage, and performance management in optimizing revenue cycle operations.

1. Revenue Cycle from Beginning to End
Created by Laura Murdock, CPPM, CMPE, SHRM-SCP, WCCP, SIP, CPC
This Photo by Unknown Author is licensed under CC BY

2. Front: Patient Access
Middle: Charges & Payer Integrity
End: Billing and Collections Services
Created by Laura Murdock, CPPM, CMPE, SHRM-SCP, WCCP, SIP, CPC

3. Front
•Scheduling and Registration
•Verification/Authorization/Patient Financial Clearance
•Medical Necessity
•Collecting Co-Payments, Deductibles, and Co-Insurance at the time of service
•Alerting patients if they have an outstanding balance
Middle
•Charge Capture
•Payer Credentialing
•Coding and Billing Compliance
•Payer Strategy & Negotiations
•Payer Contract Reviews
Back
•Claims Processing
•Remittance
•Payment Posting
•Statement Submission
•Denial Management
•Data Analytics
Created by Laura Murdock, CPPM, CMPE, SHRM-SCP, WCCP, SIP, CPC

4. FRONT END BILLING FUNCTIONS
Verifications of insurance coverage
Proper and informative dialogue with patient
Preauthorization verifications
Proper clinical documentation
Collecting Co-Payments, Deductibles, and Co-Insurance at
the time of service
Financial counseling
Created by Laura Murdock, CPPM, CMPE, SHRM-SCP, WCCP, SIP, CPC

5. MIDDLE BILLING FUNCTIONS
This should always be an ongoing process
 Credential all providers with insurance companies
 Review the provider coding (i.e. E/M service, psychotherapy,
interactive procedure)
 Ensure the providers are submitting notes on a daily basis
 Review EOB’s for reimbursement trends
 Compare contracts with reimbursements
Created by Laura Murdock, CPPM, CMPE, SHRM-SCP, WCCP, SIP, CPC

6. BACK END BILLING FUNCTIONS
 Processing all claims in a timely manner (i.e. daily)
 Reviewing all remittance advices/EOB’s
 Timely posting of all payments (daily)
 Reviewing all denials
 Statement submissions
 Payment variant analysis
 Denial posting and resolution
 Hold insurance companies accountable by reviewing
reimbursement trends
 Reporting results and analysis to upper management
Created by Laura Murdock, CPPM, CMPE, SHRM-SCP, WCCP, SIP, CPC

7.  Training and Performance Management
 Compliance
 Leveraging Technology
 Data Analysis
Created by Laura Murdock, CPPM, CMPE, SHRM-SCP, WCCP, SIP, CPC