 | Shoreline |
Revenue Cycle Management (RCM) is a critical component of medical billing that helps to ensure the financial health of medical practices. RCM is the process of managing all the steps involved in medical billing and reimbursement for services provided. It includes everything from the patient pre-authorization process, eligibility, collecting payments, processing claims, and handling denials or appeals. By following effective RCM strategies, medical practices can maximize their revenue while minimizing costs associated with administrative tasks. In this blog post, we will look at the steps involved in RCM and how medical practices should approach them to ensure success. Each of these steps requires attention to ensure accurate completion, and when done correctly, can help medical practices better manage their revenue cycle.
Eligibility and Benefits Verification is the first essential step in the RCM process since it helps to reduce errors and delays associated with reimbursement by ensuring that the patient’s coverage is valid before services are rendered. This includes verifying patient insurance coverage and confirming that the services are covered by their plan before services are provided. It is important to get this step right as it reduces the risk of patients being unable to pay for treatments or to avoid claims being denied and delayed due to lack of authorization.
Patient Demographics Entry is another important step in RCM since it helps to confirm that all data regarding the patient, such as name, address, phone number, etc., is correctly entered into a computer system for billing purposes. Accurate data entry helps to ensure that claims are processed quickly and accurately. Medical practices should use a secure system that is HIPAA compliant to store this data for privacy and security reasons.
Prior authorization is the next step in the revenue cycle management process. This process involves the provider submitting a request for authorization from the patient’s insurance company prior to providing services. It is important that this step is completed accurately and in a timely manner since it can have an impact on whether or not the claim will be approved for reimbursement. Medical practices should train their staff on how to properly handle prior authorization requests and follow up with payers when necessary.
Charge Capture is the process of documenting all services provided by a medical practice and generating a bill for those services. This includes entering all codes associated with the services provided into an appropriate system as well as any applicable modifiers or discounts used during the visit. Accurate charge capture is necessary to make certain that the medical practice receives proper reimbursement for all services provided.
Coding is the process of assigning codes to services provided by a health care provider. This includes diagnostic coding (ICD-10) as well as procedural coding (CPT). Accurate and up-to-date coding is critical since it helps to ensure that the practice receives proper reimbursement for services provided. It is recommended that practices use a third-party source to guarantee that the coding is current and accurate as these codes are updated annually and can vary on the amount of the codes that are updated at one time.
Claims Submission is the process of submitting claims to insurance carriers for payment. This includes ensuring that all necessary information, i.e., patient demographic data, insurance coverage details, and ICD-10 codes, are accurate, up-to-date, and properly entered into the system in order to facilitate timely processing by the carrier.
Payment Posting is the process of entering payments received from patients and insurance carriers into the practice’s system. This includes entering all necessary information correctly in order to ensure proper reimbursement.
Denial Management is the process of reviewing denied claims and taking appropriate action for appeals or resubmission, as needed. This helps to ensure that medical practices receive accurate and timely reimbursement for services provided. To maximize revenue and reduce financial losses, healthcare providers must have an effective denial management system in place. It is essential to accurately gather all necessary information associated with denied claims such as patient demographic data, insurance coverage details, and ICD-10 codes for billing purposes. Furthermore, staff should be trained in how to document this information without error when submitting appeals or re-submitting claims.
AR Follow Up is the process of tracking and monitoring unpaid or underpaid claims in order to ensure that they are paid promptly. This includes reviewing any denials and taking appropriate action to resolve them as quickly as possible.
Patient Statements and Follow Up is the process of sending patient statements, collecting payments, and following up with any unpaid or outstanding balances. It is important that these are sent in a timely manner as it certifies that the practice receives payment for services provided.
Reporting is the process of gathering data and generating reports to monitor performance and identify areas for improvement. Reports may include information on revenue, denials, rejections, billing cycles, collections, etc., which can help medical practices better understand their RCM processes and make necessary changes to improve efficiency.
Maintaining an effective RCM process requires dedicated resources and attention from key personnel within the practice. By investing in properly trained staff and a solid system, medical practices can ensure success. A well-managed revenue cycle will lead to increased revenue and improved patient satisfaction. The key to a successful RCM is understanding the entire process from start to finish, and being proactive in preventing any potential issues that may arise. With an effective system in place, medical practices can ensure a healthier bottom line while providing the highest quality care to their patients.
Are you looking to enhance your revenue cycle management? Shoreline can help. Contact us today to start the conversation.