[ANSWERED] What is Front-End Revenue Cycle Management?

We talk a lot about healthcare revenue cycle management (RCM) on this channel, and rightfully so! The topic is quite broad and has so many different moving parts. Overall, you should know that having an airtight RCM system is key for streamlining your organization’s administrative and clinical functions.
This system consists of three different parts. All of which hold different, but equally important roles. These parts are the: front-end, mid-cycle, and back-end. And each of these parts are made up of even more further divided stages… but we will get into that in a bit. Every point acts like a gear in a watch. So long as all cogs are turning, there’s no worries! However, if any of the gears experience issues, the entire cycle is affected.
Neglecting even one part of the revenue cycle management system can be detrimental. So much of the focus tends to go to the mid-cycle and back-end stages. Some examples of these functions are coding and billing. As well as denials management, and payment posting. But what about the front-end services? The work before the clinical encounter is just as important! Let’s take a look at this part of the cycle, the functions it is made up of, and how it affects revenue cycle efficiency.
Front-end revenue cycle management encompasses quite a few important processes. All of which involve capturing important patient information. These functions occur at the first point of patient interaction and scheduling. They then carry on through registration and eligibility verification. Making sure that these initial processes run smoothly is essential for timely revenue collection. Here are some key components of the front-end to know.
All which lay the groundwork for a smooth financial workflow:
1. Scheduling and Appointments. The process of recording patient appointments. As well as managing the timeframe of the visits. Having proper scheduling and maintaining your providers’ schedules is the name of the game. By booking a patient with the correct provider, you are ensuring that the following services provided are properly billed.
2. Patient Registration. Pretty self explanatory. You need to collect patient information when scheduling an appointment. Things like demographics, contact information, insurance information and all that jazz. Any necessary authorization or consent forms, too, to ensure compliance on your part.
3. Insurance Verification. To determine the extent of a patient’s insurance coverage, front-end staff must first verify their benefits. Healthcare organizations should check this before rendering services. By doing so, you can avoid claim denials as well as other billing issues down the road.
4. Prior Authorization. Some medical procedures or treatments may need something called a “prior authorization”. Another front-end process that is crucial when it comes to running a smooth RCM system. This means that your team may need to reach out to a patient’s insurance provider to receive the prior authorization before rendering services.
5. Financial Counseling. Helping your patients understand their part in the RCM cycle is also important. Insurance coverage, financial help, and payment options can be overwhelming to those working in the healthcare field. Imagine how your patients must feel! Offering insight on cost estimation and coverage can prevent payment surprises and reduce the amount of bills sent to collections.
6. Copay and Deductibles. Collecting a patient’s part of the healthcare costs before or right after the appointment. Getting this taken care of as soon as possible ensures that payments are met. It also prevents any possible revenue leakage.
7. Charge Capture. This front-end component ensures that all billable items from a patient encounter are captured. Documenting procedures and treatments administered helps to verify that services are reimbursed properly.
The common denominator for each of these components? They all involve the patient. You can also think of front-end services as part of the overall “patient access” experience. Having a smooth revenue cycle makes navigating the healthcare system easier for your patients, and therefore means better financial health for your business.
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