By Mark Sprague, CLC Consultant

The Revenue Cycle of a Health Center is defined by the Healthcare Financial Management Association as, "the administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue". Realistically, the Revenue Cycle is a health center's most complex financial system, driving all functions of billing - the primary source of revenue for clinics.

When managed well, the performance of a health center’s Revenue Cycle can maximize revenue and collections, accelerate revenue and cash flow, promote process improvements in the front and back office, and improve patient satisfaction.

Community Health Centers continue to struggle with managing operational costs while maintaining a high level of quality care to patients. This, compounded with the added demands of managing a pandemic, can jeopardize the success of your clinic’s Revenue Cycle performance.

A few things a Health Center can review with minimal time and effort to ensure the optimal level of performance with their Revenue Cycle are:

Credentialing process: ensuring there is a good system in place for on-boarding new providers and keeping up to date with re-credentialing deadlines.
Review Payer fee schedules and contracts: make certain fee schedules are up to date according to current market conditions.
Eliminate manual payment processing: set up payers to send Electronic Remittance Advice (ERA) and electronic payments (EFT).
Denial management: aggressively work denials. As claims age, the likelihood of receiving payment decreases.
Review your registration process: make certain workflows ensure that the registration of patients captures all necessary information for successful billing (insurance, demographics, etc.).
Provider training: identify training opportunities for providers to minimize reasons for claim denials.

CLC recommends Health Centers perform a full Revenue Cycle Analysis every two to three years. Community Link Consulting offers an in-depth Revenue Cycle Assessment that includes an on-site review and analysis, concluding with a performance report card. This helps ensure your clinic is operating with optimal administrative and clinical performance, while maintaining a healthy bottom line.