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About Hospital Outpatient Revenue Cycle Management

When you go to the hospital to have a service provided and go home the same day, you are an outpatient. The revenue cycle process for outpatients covers the charge capture, the billing, and the follow-up and collections processes for the hospital.

  1. Charge Capture

    • The procedures performed in each area of the hospital are captured in some fashion. Hospitals will use charge sheets or have automatic computer entries that contain numbers to identify each procedure that was performed.

    Coding

    • All charges must be coded by either procedure codes, revenue codes or a combination of both. All patient accounts have to be marked with diagnosis codes before claims can be passed on to billing.

    Billing

    • The billing department will send claims out either electronically or on paper. Before claims go out, they have to pass a series of edits that check such things as demographic information, type of insurance and correct insurance information.

    Payment or Follow-Up

    • Medical claims will either be paid by insurance companies or be denied with a reason code telling the billing department what to do next. Claims not paid in full will either be billed to another insurance company or sent to patients to collect on outstanding balances.

    Collections

    • Patients are given 120 days to make payment on their medical bills. They will either receive a series of statements or collection calls from the hospital on bills with high dollar amounts. If unsatisfied, these bills will go to a collection agency.

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