REVENUE CYCLE MANAGEMENT
The RCM or Revenue cycle management as the name indicates takes care of all the payment and revenue-generating processes and manages all the claims, denials and rejections on time. It uses specialized medical billing software. Health care denial management is a crucial part of RCM. The healthcare providers and the staff do a quick background information check and collect all the information needed for RCM or denial management. There are 10 steps for perfect revenue cycle management.
Let’s take a look at them:
All new patients have to go through a registration process at their first appointment to ensure a smooth billing cycle. The administrative staff gathers all the necessary information. The collected information is verified with the one provided for the claim submission to correct any errors to refrain from claim denials. It is only a one-time process and the history is saved for the next appointment.
Our medical billing team at Ibex medical billing then verifies their data with the patient’s healthcare insurance plan. The eligibility criteria and advantages are thoroughly studied. It results in an estimate of the insurance benefits and the expenses coming out of the bank of the patient. Some services require endorsement from the insurance company, other than that the insurance verification is complete.
Out team records and take a documented consent of meetings of patient- healthcare provider. It provides a history and precision about the treatment and conditions of the patient. This data is forwarded to the RCM provider to handle claim submission and denial management.
The recorded audio or video is transferred into the form of a medical transcript. All the formatting and edits are saved in the history of these medical transcripts. A strict check is maintained to avoid any errors in data to ensure the safety and health of the patient.
4. Medical Coding:
Professionals convert the transcribed data into suitable medical codes by professionals. Only skilled personnel can handle this job right. It ensures a flawless and time-saving process. The medical codes contain information about a patient’s condition (DX), services (CPT), prescription and treatment etc.
5. Charge entry:
We enter all the charges for each service clearly into a data sheet before starting any claim or denial management process. We verify and cross check patient records with insurance policy claims and enter suitable charges. Our Team removes all errors to avoid denial management.
6. Charge Conduction:
The EDI or Electronic Data Interchange transfers the error-free charges into the form of encrypted medical codes. We call it charge conduction or charge transmission. The errors can result in:
- Scrubbing: The rejection of the error fields by billing software
- EDI rejection: The rejection of invalid information
- Seeker rejection: The rejection of service claimed.
8. AR Management:
AR or Accounts Receivable manager handles the lesser denials and greater revenue generation in RCM. They keep in touch with the insurance providers and keep a check on increases in payments. The AR manager ensures the payment placements for all the services rendered. They transfer error-free details and handle the mistakes and false information.
9. Denial Management:
Denial management is a very important part of Revenue Cycle Management. It tends to reduce the denials from insurance companies for a profitable revenue generation. The follow up with the service giver and taker to maintain check and balance on both sides. Denial management involves the cause of denials and avoiding them in the future. They ensure a quick and smooth payment system.
10. Payment Placement:
Our payment placement team makes sure that all the information is correct and they manage denials effectively. They cross check the received payments and required payment to avoid any errors in the electronic remittance. We calculate insurance revenue.
These ten steps in the revenue cycle management guarantee the flawless and smooth process of revenue generation and denial management.