Where Does My Money Come From? Your Revenue Cycle Explained

by | Aug 14, 2023 | Behavioral Health, Revenue, Software

Billing Solutions Team
Billing Solutions provides medical billing services for behavioral healthcare practices.

Understanding the financial health of your business involves much more than looking at your bank balances every morning. Especially for businesses in the behavioral health field, getting clarity on how you are making and losing money can be a complex process with multiple threads to unravel. Whether you outsource your billing or have someone tackle it in-house, keeping tabs on your cash flow requires an understanding of your revenue cycle.

What is a revenue cycle?

The term “revenue cycle” encapsulates everything that happens to your revenue, from the moment that you create a client’s account until the moment that the account is paid in full. Aspects of this cycle include UR management and obtaining authorizations, providing services and clinical documentation, billing insurance claims, claims management ((including denial management and appeals, posting payments and reviewing for low payment appeals, and lastly, patient billing.

What is a revenue cycle leak?

A revenue leak occurs when you lose revenue that you otherwise should have captured. Maybe a patient claim was underpaid, or your authorization appeal was denied. There may be coding or billing errors happening that should not be missed. In every case, a revenue cycle leak is lost revenue that can be avoided if you have a transparent view of each stage of your cycle.

How can you create a healthy revenue cycle?

Revenue cycle management involves a set of best practices that have been developed over years of analysis. Just like physical health, revenue cycle health requires constant maintenance and attention. In the behavioral health industry, one of the most crucial practices is claims management. Insurance companies have made it more difficult than ever for providers to get paid for their services. Ensuring that you do depends on many factors, from submitting your claim in each insurer’s format, to managing denials and appeals. Here, experience is crucial. You’ll save time and money when you have an experienced billing team that avoids mistakes and missteps at this phase and works with you each step of the way to let you know what they require from your clinical and administrative team to be successful.

How do you know if your revenue cycle is healthy?

Again, tracking the financial health of your organization involves so much more than the bottom line. All behavioral health organizations should be tracking the status of their authorization and billed claims. If you don’t know that your billed claims are getting repeatedly denied for the same reasons–and why they are getting denied—you’ll keep wasting time and money. And if you can’t easily track that your claims are being worked you have no accountability and no way to search for paths to improvement.

Once you know what to look for, will you be able to find it? Do you have the time to dig for the answers that you need?

Working with a trusted advisor like Billing Solutions means that all of the key numbers you need to know will be provided for you, so you can find and address problems before they become bigger ones. Our proprietary software, Nectar, is the most advanced technology in the field, providing a constant laser-focused view on the information that is most crucial for you to know.

We categorize your outstanding claims in order to give you a global view of where things are at. With drill down capability that allows you to easily see the last action we took on your claims, what that action is, when we will take the next action and what that next action will be, you can always feel assured that your billing team is moving your revenue cycle forward. And with our denial write-offs tracker, you’ll always have the transparency need to spot those revenue leaks.

If you’d like to find out what red flags you’re missing, and how much revenue you’re passing by, contact us today for a free account analysis. We’ll review your data and give you a sneak peek at how the Nectar portal can help you get a clear view of what’s happening inside your company, 24/7.

Now more than ever, every dollar counts. Are you confident that you’re not missing out?