Revenue cycle management is a basic and a very critical part of medical billing services. Each organization has its own cycle of claims and cases management, yet for viable revenue cycle management, certain processes should be sorted together. When these processes are performed efficiently for the medical billing services, it improves the overall performance of your revenue cycle.
Below are the 10 key steps:
1. Patient Registration
The cycle of medical billing services and coding begins with patient enrollment. The front office staff takes essential information and data from the patient to set an appointment for the specialist before the treatment. When the patient registers with the doctor, medical billing services organizations take their medical record to accurately make their respective case.
In addition, proficient medical billing service specialists guarantee the precision of the data provided in the initial step of registration.
2. Insurance coverage verification offered by the medical billing service provider
In this specific step, third-party medical billing services ensures a careful verification of the patient’s insurance coverage. The healthcare plan is then dissected to check eligibility criteria and the compliance of processes.
After the confirmation cycle, medical billing service specialists then check the patient’s obligations, for example, deductibles, copayments, and cash-based costs that they need to bear. Sometimes, initial approval is essential from the insurance agencies before the medical services are delivered. Most medical billing services utilize online mediums to store and check the data.
3. Recording information about the patient’s experience
The doctor and patient experience are mainly recorded or archived to track the patient’s overall diagnosis and treatment. It helps medical billing service providers and coders to bill the performed services for exact claims.
4. Transcriptions of medical information
Medical transcriptions refer to the documentation of moving video or sounds of the patient’s experience with a doctor in a proper billing design. After the medical billing service organization gets all the vital data, they start with the original billing of the services. The exactness of data is constantly kept in mind, and outsourcing or using third-party medical billing services organizations additionally guarantee the HIPAA-compliant services.
5. Medical Coding
As obvious as it is, this is the ideal opportunity to allocate medical codes to medical records. The cycle is to streamline the billing process for revenue cycle management as it is difficult for payers to peruse the total medical history of patients. Accordingly, medical coding is significant and saves time. Only experienced coders are permitted to code, who are aware of the Current Procedural Terminology codes, and ICD 10 codes.
6. Medical Billing Services
Prior to sending cases to insurance agencies, it is critical to charge delivered services by the healthcare service provider to quantify the number of payments needed for the provision of those specific treatments and services. The records of patients are again checked to correct any mistakes or errors. In case of any problems, insurance agencies deny claims or essentially reject them, which affects the revenue cycle management and increases the pace of records receivable (AR). So, make sure that your practice is sorted with the medical billing services.
7. Transmission of charges
It is the step where claims and cases are submitted to payers, either government or private, by means of EDI (Electronic Data Interchange). Additional measures are taken to gather clean cases when sent through EDI.
There come three circumstances in instances of cases with mistakes.
- Required fields are to be filled, in any case, the framework dismisses the case – a cycle known as cleaning.
- Cases with invalid data are likewise dismissed by the framework.
- The framework additionally dismisses the cases that are not incorporated according to the payers’ approaches.
Here, the medical billing service providers need to check twice each measure that no data gets lost.
8. Management of account receivables
The account receivables calling group determines the status of each claim after it is submitted to specific insurance agencies. The motivation behind this added step is to guarantee payment posting in an effective way. This group is likewise liable for sharing any extra data like record subtleties and helps eliminate blunders in claims so that they are not rejected. They likewise compare with the doctors, patients, and insurance agencies and advise them about any update to keep the revenue cycle management efficient.
9. Management of denied claims
This step takes into account the claims which are denied by the insurance agencies of the patients. In some cases, a few claims are not compiled efficiently with all the data that is required. Denied claims management specialists are responsible to sort such issues. Steady subsequent services are important for denial claims management that ideally recognizes mistakes, correct them, and repay doctors without any hitch.
Follow up services, being a huge part of the management of denied claims, monitor the execution of the claims. It is also done to boost the repayment rate for a practice and revenue cycle management. Eventually, no case goes to the point of rejection or gets dismissed over minor issues. When medical billing services submit cases to payers, the subsequent group dissects the handling of claims deliberately. They are mindful to separate denied claims from the accepted ones and speak with partners (insurance agencies, patients, clearinghouses, etc.)
10. Posting of payments
This is the end of the medical billing service and coding process that updates your team about the overall situation of payments. EOB (Explanation of Benefits) and ERA (Electronic Remittance Advice) all are given to the concerned patients. The team responsible for the posting of payments additionally checks if the payment that is received is precise. These ten stages portray the total cycle of medical billing services and are critical to keeping the revenue cycle management run smoothly.
Benefits of effective revenue cycle management
Revenue cycle management (RCM) in medical care fills in as the focal cycle that smooths out other processes related to payments and collections, guarantees consistent appointments, and makes the medical care suppliers monetarily practical. The U.S. Department of Commerce reports that an account 60 days past due has only a 70% chance of recovery. After six months, it has only a 30% probability of being paid.
Here are a few advantages of revenue cycle management in medical care:
– Improved Patient Experience
Effective revenue cycle management dispenses with the repetitive cycles, improves the complexities, smooths out the framework. This brings down the regulatory weight of the health care suppliers and they center more around conveying quality consideration services. Effective revenue cycle management with the automation of other processes improves all the touchpoints of a patient experience and closes the cycle with convenient payments.
– Decreased burden on the medical front office
Even though the revenue cycle management process runs alongside the patient walkthrough, however, overseeing it is a finished task that requires focus and consideration of the revenue cycle management assets. This is the reason the greater part of the medical care services providers looks for services of the expert RCM suppliers who can viably oversee and automate their revenue cycle.
By rethinking and automating the revenue cycle, medical services suppliers can liberate them from various authoritative assignments that incorporate asset management, billing, and coding, dealing with the claim management and repayment amounts. Greater accessibility of time encourages them to center around conveying quality services.
– Mitigation of Errors and Redundancy
Generally, RCM suppliers additionally give medical billing and coding services. Postponement in the appointment cycle happens because of blunders in the billing reports. Medical billing arrangements joined with revenue cycle management helps in wiping out the mistakes and it eliminates the repetition in the system. Mistake free billing and appointment work process boosts the revenues of medical services suppliers.
– Fewer Denials of Claims, Better Claim Management
At the point when the revenue cycle is streamlined and takes out the errors in the framework, it consequently brings down the denial rate of cases and claims which may have been higher prior to its introduction. Payments of the medical care suppliers are denied because of blunders in the payment claims and when these mistakes are taken out, it limits the denial rate of those claims.
– Rearranged and Improved Processes
Revenue cycle management and automation of certain processes help in disentangling the front medical office area and back-office processes. The computerization of the situation whenever dealt with the privilege of clinical innovations, for example, the electronic health record (EHR) framework, can improve the overall work process. It improves the booking cycle of appointments, medical coding and medical billing, and preparation of payments for the practice. Eliminating the complexities in the work process is an unquestionable requirement to improve the operational effectiveness of the suppliers and to ensure that they are meeting their determined revenue targets.
See Also: Digital RCM Is The Future Of Healthcare
Maximization of Collections and Revenue of your Practice Effective revenue cycle management enhances the revenue cycle for any practice or hospital. RCM suppliers can deal with the officeholder undertakings alongside accumulations, for example, payment denials and subsequent meet-ups, and ensure that the health care service suppliers are repaid. The cycle carries precision to the framework and pretty much rules out blunders. The cycle whenever joined with the mechanization methods and programming applications, all the time taking undertakings, for example, insurance coverage check, medical coding, and insurance preparation takes less time than manual systems. An advanced work process helps in boosting the cycle as well.