Lesson · 20 min
Workflow, Revenue Cycle & CPOE Review
Comprehensive review of patient workflow, revenue cycle management, clinical preauthorization, and CPOE before tackling advanced topics.
By the end of this lesson you can
- Place any revenue cycle activity in its correct phase
- Trace a denial back to the phase that caused it
- Connect CPOE to the documentation that supports a claim
📘 Reading Lesson
Lesson Notes
Read through the key concepts before you try the challenge.
Three phases, one cycle
| Phase | Also called | Covers | Typical failure |
|---|---|---|---|
| Front end | Patient access | Scheduling, registration, eligibility, authorization, point-of-service collection | Coverage not verified; authorization missed |
| Middle | Health information management | Clinical documentation, coding, charge capture | A service delivered but never charged; documentation that does not support the code |
| Back end | Patient financial services | Claim submission, payment posting, denials, appeals, collections | Claims not worked before the filing deadline |
Denials surface at the back end and usually originate at the front. When you group a month's denials by the phase that caused them rather than by the department that received them, the picture changes completely — and so does what you would fix.
Key Concepts Review
Before moving into EHR databases and financial management, let's consolidate the core workflows you've studied so far.
- Patient workflow: scheduling → registration → encounter → coding → billing
- Revenue cycle: front-end (access) → mid-cycle (coding) → back-end (billing/collections)
- Preauthorization: required for certain procedures, medications, and specialist referrals
- CPOE: electronic order entry reducing medication errors and improving communication
These concepts are interconnected. A gap in any step of the workflow — registration error, coding mistake, or missing preauth — creates downstream revenue problems.
Challenge
Apply what you've learned in this lesson.
Check your understanding
Which phase of the revenue cycle involves submitting claims to insurance payers?
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