MAJOR STEPS INVOLVED IN THE REVENUE CYCLE MANAGEMENT


Revenue Cycle Management is the process of identifying, collecting and managing the practice’s revenues based on the services provided. RCM process is essential to maintain financial viability and continue to provide quality care for their patients.


The revenue cycle begins with the patient appointment and ends with successful payment. There are many steps in between the revenue cycle management in medical billing which is done accurately and efficiently completed to ensure timely payment.


Medical Billing Outsourcing Company


It is the first step which helps to decide whether to install RCM software in-house or not. This task is handover to a revenue cycle management company. With this, it will become easier when you outsource medical billing services with skilled personnel to file claims, work on the denials and appeals on your behalf.


It is easy to look for revenue cycle consulting companies near you when you don’t find an expert staff member in your organization. When you run a practice with IT crew support, it is ideal to run an RCM software setup on local servers. Larger organizations which lack in skilled staff, go for the medical billing services.


Patient Pre-certification

When a patient undergoes pre-authorization, the physician’s office pre-approves the patient for certain treatments and drugs prescription in this process.


The payers or the health insurance companies will decide whether the prescripted drugs, procedures, services are medically necessary or not. Based on the decision, the services rendered. The pre-authorization phase may face some exceptions in case of medical emergency.


Eligibility and Verification


This process is not done over the phone because it demands a lot of time and accuracy.


Charge and Code


The patient’s visit to the office transforms into a set of codes. Therefore the professional medical coders go-to the people for it. The codes follow a certain set of rules with the CPT guidelines and the latest ICD-10 coding system.


Deductibles


Every health plan comes with a deductible and a co-payment. Some have high deductibles, and some have low deductibles. Depending upon the amount, the patients pay the copays to the doctor’s office. It is the amount fixed in a plan that you will pay before the insurance company starts paying for those health care services.


File Claims


Submission of claims is the important stage in the process because the reimbursement directly depends on it. If it gets flawed, the chances for reduced payments or denials increase. As soon as the biller prepares the claims, they are filed with the insurance companies via the clearinghouse and makes sure they are clean and free from errors.


Reimbursement for the Rendered Services

It is time when the insurance company has to pay up. The payers match the procedures under the coverage limit. If they find the bills appropriate, then the process of acceptance becomes smoother and returns maximum reimbursements. In case of incomplete patient information or any other issues, the denials are inevitable.


There are many hospitals and other medical institution which delivers comprehensive Healthcare and Medical Revenue Cycle Management Outsourcing Services. They offer a systematic approach to the safety of patient information and maximizes efficiency.

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