As a healthcare provider, there are a lot of factors that will affect the success of your medical practice. One of them, and the most vital, is revenue cycle management.
It’s imperative to focus on saving your patients’ lives and treating them using the highest quality standards. But, you’ll only deliver quality care if your practice is financially healthy.
The medical revenue cycle management process is critical for ensuring that your medical operations are smooth. This means that you need to understand the different steps in the process and how they work together.
Understanding the process will ensure that you manage your finances well and get the most out of your reimbursement.
Here, we take a closer look at the medical revenue cycle management process, including what it entails and the steps involved in it.
- 1 What Is the Revenue Cycle Management Process?
- 2 What Are the Steps in the Revenue Cycle Management Process?
- 3 Understand the Revenue Cycle Management Process
What Is the Revenue Cycle Management Process?
Revenue cycle management (RCM) is your medical practice’s process of tracking patient care encounters from start to finish. The cycle begins when a patient schedules an appointment and ends when you receive payment for the services rendered.
The goal of RCM is to optimize your practice’s financial performance by improving efficiencies in medical billing and collections. Cycle management will ensure that you receive quick and accurate reimbursement for your healthcare services.
The revenue cycle management process has various benefits. Examples include:
- Identifying and addressing errors in the revenue cycle
- Reducing the administrative burden
- Minimizing cases of healthcare fraud
Increasing your facility’s revenues is also another good example.
What Are the Steps in the Revenue Cycle Management Process?
You’ll need to follow several steps to achieve effective revenue management in your healthcare practice. The most crucial steps include the following:
Preregistration will help you establish the patient’s coverage, co-insurance, co-payments, and whether a referral is necessary. At this stage, you should inform the patient of your financial expectations. Tell them when they’re expected to make a payment and about your policy for appointment cancellation.
Preregistration will allow you to set the right financial tone before you begin treating a patient. It’ll prevent conflicts with your patients about payments.
The goal of registration is to solidify the preregistration process. Its main goal is to ensure that the patient’s information is 100% accurate. You should ensure that the following patient’s details are correct at this stage:
- Phone number
- Date of birth
- Insurance information
You’ll need this information to send billing information to your patients.
You should collect co-payments at this stage. If you’re a specialist, you should ensure that there is an authorization or a referral requiring you to treat the patient. If there’s no referral, you won’t receive payment for your services.
Other things to consider during registration include signing forms and assigning insurance benefits. If you miss these steps, you might face financial repercussions if the payer audits you.
After treating the patient, you should document the charges in your practice management system. The information you include should be as accurate as possible to ensure proper medical billing.
You can automate the process whereby you capture the data electronically as the patient moves from one stage of care to another. The charge capture can also be manual, whereby your front desk staff captures the information and sends it to billing for manual keying in.
After capturing the charges, you’ll need to convert them into codes. These are standard medical codes that you’ll use to submit a claim to the payer. They represent the services you provide to the patient and diagnoses.
If you don’t want to miss charges, you should code them correctly. The process can be daunting, so hiring medical billing and coding services is vital.
These services understand all the codes in all medical care practices. Service providers like Coronis Health will take care of everything, including your laboratory medical billing, to maximize your reimbursement for laboratory services.
Once you code the charges, you need to send a claim to the insurance provider. You should understand all the requirements of each payer before sending the claim. Remember that if there are errors in your claim, the insurance company will delay your payment.
If you submit paper claims, ensure that you follow all the requirements for formatting and printing. If you submit electronic claims, you should ensure that you use the right software. You can have a billing and coding expert review your claims for errors.
After submitting the claim, you need to follow up with the payer. The correspondence will allow you to check on the status of your claim. If there are delays in payments, this is the stage where you’ll receive an explanation from the payer.
You should also use this opportunity to resubmit any claims that have been denied and appeal any denials. You should understand the reasons for denials and use this knowledge to improve your claims in the future.
Once the insurer pays you, you can now bill the patient. You should send them a statement that shows all the services you provided and how much they cost.
If the patient has insurance, you should indicate the amount that their insurance covers. You should also include any outstanding balances that the patient is responsible for.
You can send paper bills or use a patient portal to bill your patients. You should consider using a patient portal as it’s more efficient and will save you money in the long run.
If the patient doesn’t pay their bill, you’ll need to take action. This is where collections come in. You should hire a collection agency to help you get paid.
The agency will contact the patient and try to negotiate a payment plan. If the patient doesn’t cooperate, the agency will take legal action.
Once the process is over, you can review it and see how you can improve your revenue management.
Understand the Revenue Cycle Management Process
Understanding and following the medical revenue cycle management process can help you improve your cash flow and avoid financial problems. Our article has all the information you need to know about the process. You should consult an expert if you need help with any of the above steps.
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