What Is the Healthcare Revenue Cycle?

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The healthcare revenue cycle is the process of getting treated by a doctor. It also involves physicians getting paid for it. This process ensures everything squares away with the insurance and your wallet. Billing staff take all that information and verify that it’s all correct. Then, they send it off to your insurance company.

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They play the intermediary, negotiating prices and keeping everything legitimate.

Once your insurance gives the thumbs up, they send some cash straight to the doctor. But it’s not over yet. Your insurance plan has its own rulebook on how much you might still need to pay. That’s where the billing department swoops in. Essentially, you may still owe a little bit. Once you take care of that last bit, you’re good. The cycle is complete.

Doctors write special codes that act like a secret message to the patient’s insurance company. This message says what happened during the visit and why the doctor deserves payment. The insurance company then decides if they’ll pay the bill or not. If they say yes, the situation is officially squared away.

If they say no, the hospital might have to argue their case. Finally, after all this back-and-forth, someone pays the bill, and everything gets recorded. That’s the short story of how money moves in the healthcare revenue cycle. This quick glimpse barely scratches the surface, and if you’re curious about physician billing management, watch this video.

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