Revenue cycle refers to the payment and reimbursement process for healthcare services in the U.S. Without proper management, revenue cycle errors can cause significant financial losses for providers. How can you maintain an effective revenue accounting system in your practice? Also, should you consider hiring an outside revenue cycle management (RCM) specialist or rely on your in-house medical billing system? A medical billing blog outlines the steps in the revenue cycle you need to execute efficiently and effectively.
1. Pre-Authorization/ Pre-Registration and Registration
This initial patient contact is essential for gathering accurate information for billing, including the patient’s date of birth, address, phone number, and insurance carrier. Once you can contact the insurance, you can find out the patient’s eligibility for coverage, as well as their deductible and co-payment. All of this can be done quickly through your medical billing management system, which allows you to find insurance information through an online directory.
Once you can verify all eligibility information, double-check all patient demographic information to ensure it’s accurate. Errors can cause reimbursement delays after you submit claims. Specialists must have documented authorization before treating a patient. If this information is missing, you might not get paid for the treatment you provided.
2. Capture Services and Charges
After the provider sees a patient, the medical billing department assigns official codes to the services that took place during the appointment. This process, called charge capture, takes all of the patient’s billable treatments and procedures and lists them as charges for the insurance carrier to review. High-quality coding, which might include claims scrubbing software, will help minimize denials after initial claim submissions.
3. Claim Submission And Management
After your billing team and RCM specialists approve a claim for submission, it is sent to a clearinghouse. If a claim is denied, you can quickly fix and resubmit it using your RCM vendor and your office’s billing system. One way to troubleshoot your practice’s submission issues is to carefully review your claim transmission and rejection reports. If you can pinpoint coding errors or other problems early on, you can prevent repeated claim denials and lost reimbursement.
4. Payment
Upon claim review, insurances post an explanation of benefits, also known as remittance processing. Patients will know how much of their bill was covered by their insurance versus how much they need to pay out-of-pocket. If your billing system has an automated online portal, you can direct patients there to view their insurance payment information and pay bills directly.
Also, remittance allows the healthcare provider to see how much the insurance company reimbursed them for their services. Much of the fees and reimbursement standards are spelled out in the contracts between the providers and insurance carriers. In order to catch errors or inconsistencies, it might be best for RCM and in-office billing staff to review your contract fee schedules on a regular basis. That way, you can notify insurance carriers of issues or appeal payment decisions. To learn about recommended insurance remittance and quality control methods, your medical practice may benefit from looking at a medical billing blog.
5. Quality Control
This last phase of the RCM process ensures that your billing system is effective and is using the best methods for insurance reimbursement and patient payments. One approach to quality control is to have RCM and your billing staff meet as a team to examine your “insurance follow-up”. You can find out the reasons for outstanding charges and consider assigning staff to manage specific insurance carriers.
When choosing a billing system for your practice, consider outsourcing to find a dedicated and knowledgeable RCM expert. Together, your billing staff, billing software, and RCM team can help fine-tune your revenue cycle to generate the best reimbursement rates and prevent considerable time and payment losses.
