Submitted on Wed, 2015-03-18
By SMART Health Claims

These are the three most important public health revenue cycle management words that should be a part of your everyday vocabulary.

3 Words for Building a Better Public Health Billing Department

Maximizing revenue, contracting and credentialing, claims processing, patient statements, insurance verification – these are not the most cherished words for public health professionals. Terms associated with Revenue Cycle Management can often seem foreign and complex.

Quite simply, Revenue Cycle Management is just a fancy way to describe the process of bringing in revenue for the services that your health clinics provide. The lexicon of terms used to describe this process makes it seem much more complicated than it actually is.

Making the process easier for your agency starts with adopting some basic revenue cycle terms and incorporating it in your daily routine. A few very simple adjustments can bring a world of immediate, tangible changes to your agency.


These are the three most important public health revenue cycle management words that should be a part of your everyday vocabulary:


1. Verify. [ver-uh-fahy], Verb
To prove the truth of, as by evidence or testimony; confirm; substantiate.

Verifying patient eligibility is a crucial step in effective Revenue Cycle Management. Adding this word to your daily routine will not only help generate more revenue but it will save precious time and headaches by improving your operational processes.

Verifying patient eligibility is a win-win situation. If a patient does not have active coverage, you can generate a self-pay invoice while the client is still in your office. If a patient is verified with active coverage, but is later denied for inactive coverage, you can use the eligibility report to contest the rejection.

Regardless of how confident your patient is about their coverage, you should verify the eligibility of patients. This is also an opportunity to confirm the correct address, date-of-birth and coverage information on file with their payer to make sure that it matches what the patient has provided.


2. Contract. [kon-trakt], Noun
An agreement between two or more parties for the doing or not doing of something specified.

The only way to guarantee maximum reimbursement with healthcare payers is with a contractual agreement. The contract is integral to setting prices and establishing a process that will produce consistent, reliable revenue.

Contracts are incredibly important because most heatlhcare payers do not accept claims from providers without a contract. Payers that do accept claims from un-contracted providers generally reimburse at much lower rates.

Consistently speaking about what healthcare payers you are, and are not, contracted with shines light on a critical issue. Even though it can be an arduous task, you should be contracted with all of your healthcare payers. We recommend using a public health contracting specialist who understands reimbursement rates, provider status, timely filing deadlines and the processes and procedures of local health departments and community health centers.


3. Post. [pohst], Verb
To put up a notice in a public place, to announce, to submit an online message.

Posting payments, as you receive reimbursement checks, is a huge benefit to your agency. It allows you to keep tabs on all outstanding claims and to follow-up with problematic claims more efficiently.  

This also fosters more accurate data reporting and allows you to make decisions based on numbers and facts. If you determine that a particular payer has consistently under-reimbursed claims, you may have to stop accepting that coverage. If you provide a service that causes problems across all of your payers, you may need to stop providing that service.

Posting payments provides backend analytics that are crucial for for your revenue cycle. Using this term consistently will help you build a smarter, more intelligent program.


At Upp Technology, we know that simply using these three little words more often will improve revenue cycle management process. Embracing these terms removes complexity from something that is traditionally is very hard-to-understand. An easy way to maximize revenue in your agency is to focus on simple, uncomplicated things like verifying the eligibility of every patient, getting a contract with all of your healthcare payers, and posting payments as you receive reimbursements.

Our public health billing and contracting specialists can maximize revenue at your local health department or community health center. Our easy-to-implement healthcare claims management solutions and process will help develop self-sustaining revenue for the services you already provide. Learn more about how we make revenue generation for public health easy.

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