1. Revenue cycle operations There are three functional areas in the revenue cycle (improve revenue cycle): front end, middle, and back end.

2. FRONT-END PROCESSES Pre-registration Scheduling Patient Access and Registration Pre-authorization, Pre-certification, and Insurance Verification. Point-of-Service Collections and Financial Counseling.

3. MIDDLE PROCESSES Clinical Documentation/Medical Records. Charge Capture and Coding. Charge Master and Master Patient Index. Late Charge Reductions. Case Management.

4. BACK-END PROCESSES Billing: Primary and Secondary Insurance. Reimbursement, Posting, Refunds, and Adjustments. Follow-Up/Tracking. Denial Management. Bad Debt and Collections. Customer Service: Front, Middle, and End Processes. Management Expectations.

5. Quality measurements and metrics are important elements in the evaluation cycle, especially related to process improvement, for several reasons: Metrics support the analysis, recommendations, and conclusions—you cannot argue with quantifiable data. Metrics establish the tone where both negative and positive outcomes are measured. Metrics provide a mechanism for understanding outcomes and a way to obtain employee buy-in to change.

6. Metrics establish accountability, especially for those employees not performing to par. Metrics provide data to leadership, enabling them to focus of issues, problems, and resolutions. Metrics are also used as a means to celebrate improvement once attained.