A Beginners Guide To Understand the Revenue Cycle Management
Unable to understand the basics of the revenue cycle management system, right? The medical billing RCM system is a process of money flow management by tracking the scheduled appointments, checking coding procedures, and collecting payments. The purpose of medical billing RCM is to ensure fair medical billing, improve the flow of cash, and refine the experience of patients.
It is a systematic process that ensures that healthcare providers are accurately paid for their services. There are various significant factors that play a vital role in order to maintain transparency and ensure accurate billing. Summing up all in a paragraph is a daunting task, so come with me to explore the basics of the medical RCM system.
Basics of Revenue Cycle Management
1. Patient Appointment Scheduling in Medical RCM
The process of medical billing RCM begins when a patient schedules an appointment. The appointment schedule process is based on patient registration in which a staff member records the demographics of the patient and then makes a short report on the addressed issues.
Factors of Appointment Scheduling
- Collecting the demographic data of a patient.
- Verification of a patient’s personal information.
- Verification of a patient’s insurance information.
- Creating a patient’s account.
2. Providing Healthcare Services in Medical RCM
Once the demographic data is collected and the information is verified, the process of healthcare begins. It encompasses the treatment provided by the healthcare professionals, including the surgery, medicines and additional services offered to the patient. All the services provided by the healthcare professionals are recorded.
Factors of Healthcare Services
- Documentation of all the services provided to a patient.
- Communication with patients in order to eliminate barriers.
- Ensuring all the healthcare regulations and laws align with the provided services.
3. Coding & Billing in Medical RCM
The third and one of the most significant steps is coding and billing in which all the services documented in the above step are translated into medical codes. These medical codes ensure privacy and enable various healthcare bodies to communicate about the condition of a patient without revealing the actual identity of a subject.
The codes are also used to create bills and then submit claims. Billing is a complex part of the entire process of medical billing RCM, and in case a healthcare provider commits a mistake while creating a bill, it can face legal proceedings. Additionally, it is significant to ensure that billing and coding adhere to healthcare regulations.
Factors of Coding & Billing
- Reviewing coding and billing before submitting claims in order to catch mistakes.
- Making compulsory corrections in order to eliminate chances of denial.
4. Submission of Claims in Medical RCM
Another highly significant step is the submission of claims after coding and billing. It is recommended to review documentation more than once in order to identify billing errors and then submit claims. Claim submission within a specific timeframe can eliminate the chances of denials.
Factors of Claims Submission
- Tracking the after-process of claim submission.
- Developing a strategy to avoid payment rejections.
- Ensuring laws and regulation adheres to the current healthcare laws and regulations.
5. Payment Processing in Medical RCM
Payment processing refers to the collection of payment and updating the subject’s payment status. It may take a few more days to receive payment from the insurance company based on the policies of the company. The medical billing RCM system also ensures that the payment method meets the eligibility criteria of regulations established by the government.
Factors of Payment Processing
- Reviewing claims in order to verify accuracy.
- Receiving the claimed amount and then confirmation of payment reimbursement.
- Providing a financial report to both healthcare providers and patients.
How to Manage Denial in Medical RCM?
Denial is a common problem that occurs due to neglecting the errors while documentation, coding and billing. There are various consequences of denial, such as an insurance company may deduct a small amount or it can reject the claim. Here are the simple ways to prevent denial:
Identify Reasons for Denial in Medical RCM System
The primary reason for denial is the code or documentation error. Basically, the claims submitted to an insurance company are reviewed by experts. If they find something suspicious, such as a wrong code or miscalculation, they report it to the finance department and it decides whether the claim should be rejected or not.
- Misinformation
- Miscalculation
- Unauthorised claims
- Eligibility issues
Checking Patient’s Information
It is recommended to check the information of patients from the beginning to the end. Simply put, review demographics, check documentation, verify codes, examine billing reports and ensure that healthcare provider and patient both follow regulations. Submit claims within a specific timeframe.
Final Thoughts
The revenue cycle management system is an essential aspect of fair transactions, transparency in money flow and sustainability of healthcare organizations. It encompasses a step by step process in which the accuracy of the information plays a significant role. In case, there are errors in billing, coding or in documentation, the submitted claims are rejected by the relevant body, but we can prevent such conditions with the help of the steps explained above.
Learn the basics of the medical revenue cycle management system along with its step by step procedure and see how to manage denial in medical RCM.