The patient revenue cycle

A new organisation cannot bill a single visit until each of these exists. Every item is done on a screen. A missing item shows up later as a hold reason or a refusal that names it, not as an error page.

1. Book and run the visit from ArkCloud Rehab → Outpatient → Schedule, under a catalogue service. Start visit creates the encounter; Complete finishes it. Any Rehab user (Agent, Supervisor or Administrator) can do this.
2. The service is recorded automatically when the visit is completed: procedure code, modifiers and units from the catalogue, diagnoses from the episode (the primary plus up to three secondaries), date of service from the visit. If it cannot be recorded - a free-text booking, a retired service, no encounter - the schedule says why and nothing is invented. A service can also be recorded by hand from Records and revenue → Encounters → Record service, where minutes can be entered.
3. Units. Units are the catalogue default unless minutes are entered. For a timed code with minutes and no units, units follow the 8-minute rule (8-22 minutes is one unit, 23-37 two, 38-52 three), and fewer than 8 minutes is refused. The per-visit 8-minute check is a warning; it never rewrites units. A visit completed from the schedule records no minutes, so the check cannot run for it.
4. Sign the note from the episode's SOAP notes. Signing re-checks billing readiness. Who may sign billable care is decided by licensure - discipline grant, active Workforce link, a credential valid on the signing date - not by role. A supervised author's note also needs the supervisor's co-signature.
5. Read the hold reasons on Records and revenue → Billing (the screen title is Charge capture). Every failing rule is listed, in the order documentation, coding, coverage, authorization. See Rehab charge capture.
6. Post the charge. An administrator presses Post charge on a Ready to bill row. The gate is re-run under a row lock, the rate is read for the date of service, the charge is created and posted to the account, and any authorization unit is consumed - all in one transaction, or none of it.

1. Build the claim: ArkCloud RCM → My Work → Accounts → (account) → Insurance Information → Build Claim. The claim is assembled from the account's posted, unbilled charges for one coverage. Amount, dates and payer all come from the charges; nothing is typed. Charges from a self-pay episode never go on a payer claim. Requires the submit_claims permission (administrators).
2. Read the scrub report returned with the new claim: a score and a list of likely payer rejections (patient, insurance, provider, diagnosis, procedure, date and billing checks). It is a report, not a gate - the claim exists whatever it says.
3. Submit: ArkCloud RCM → Insurance → Claims → (row menu) → Submit to clearinghouse. Only a Pending claim built from charges can be submitted. The 837P is generated and validated first; a claim that fails is refused with the reasons and nothing is sent. The file is then uploaded to the clearinghouse mailbox and the claim becomes Submitted. Administrators only.

Replies come back as files: a 999 (the file was readable), a 277CA (each claim accepted or rejected at the front door) and an 835 (the payer's decision and money). With a configured mailbox the worker collects them every 15 minutes, works out which organisation each belongs to from the claim numbers it names, and applies it. A file it cannot place is left in the mailbox and reported, never guessed. Without a mailbox, billing staff (Agent, Supervisor or Administrator) upload the same files on ArkCloud RCM → Insurance → ERA/EOB Posting, which runs the same posting code.

Secondary payer. When the primary has decided and a balance remains on an episode with secondary coverage, the claim appears on ArkCloud RCM → Insurance → Ready for secondary. Bill secondary creates the secondary claim with the primary's line-level adjudication; it is then submitted like any other claim. Nothing creates it automatically.

Patient responsibility from the 835 lands on the charges automatically. A claim built from charge lines can also be moved to the patient deliberately (Transfer to patient, administrators).

Mostly. Where they do not, it is listed here rather than left for a patient to discover.