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    03 — Value stream · VS-510

    Encounter-to-Cash

    Turn care that was delivered and documented into payment: capture the charges, code the encounter, bill the payer, post what it pays, work denials, and bill and collect what the patient owes. Paying claims as a health plan is Claim-to-Payment.

    • Patient Revenue Flow
    • Patient Accounting Cycle
    • Charge-to-Cash
    • Charge-to-Payment
    // FIG. 03 · Stage flow
    1Capture Charges2Code3Bill the Payer4Post & Reconcile5Work Denials6Bill & Collect fr…
    1. 01

      Capture Charges

      VS-510.10

      Capture every billable service from the record and reconcile charges against the work done.

    2. 02

      Code

      VS-510.20

      Assign diagnosis and procedure codes from the documentation and query clinicians where it is unclear.

    3. 03

      Bill the Payer

      VS-510.30

      Scrub and submit a clean claim to each payer in coordination-of-benefits order.

    4. 04

      Post & Reconcile

      VS-510.40

      Post payments and adjustments from remittances and compare them with expected payment.

    5. 05

      Work Denials

      VS-510.50

      Correct and resubmit or appeal denied claims and fix the cause upstream.

    6. 06

      Bill & Collect from Patient

      VS-510.60

      Send the patient a clear statement, offer payment plans and assistance, and collect the balance.