The term “revenue cycle management” is most commonly used to refer to the medical claims that hospitals and doctors submit on behalf of the patients they serve. Revenue cycle management companies are the heart of hospitals, insurance companies, EHR companies, and billing companies. The core responsibilities handled by revenue cycle management companies are to identify, verify, and collect the payments. To accomplish these responsibilities, healthcare revenue cycle management companies get attached to patients, hospitals, and insurance companies.
Moreover, it also comes in contact with the EHR company and billing section. Beneficiaries must outsource revenue cycle management companies in order to operationalize the revenue cycle on a daily basis. By outsourcing revenue cycle management to companies’ hospitals are free from the burden of billings, coding, claim submission and denials, payments, and much more. All of the mentioned, from scheduling an appointment to the exit of the patient are operated under revenue cycle management companies. For doing so company follows a specific procedure which is mentioned under.
Steps to complete process of revenue cycle Management Company
Step 1
The revenue cycle management company’s first step is to arrange a schedule for visiting patients. This step is crucial because by enrolling patients, medical billing company investigates their medical insurance. Which is responsible to cover their medical bills. Therefore, the patient schedules an appointment with the healthcare provider and confirms whether their medical insurance should use or not with that specific healthcare provider who has to outsource revenue cycle management company.
Step 2
The second step owned by the revenue cycle management company is of maintaining checks and balances on whether the patient is eligible for claims or not. If the patient is eligible for a claim, for which services or diagnosis the claim is valid. Could the insurance claim cover catastrophic, non-catastrophic, or minor injuries or not? Such information is primary share with the patient.
Step 3
In the third phase, the real action is execute by the company. Here, the patient receives the prescribed treatment in the hospital setting and leaves after it is once over. After that, the revenue cycle management running company will receive a thorough report regarding the patient and the therapy.
Step 4
In the fourth step, the whole procedure of this phase is handle by the medical biller. where he manages the patient’s information and prepares claims for the insurance company Along with preparing claims medical billers also check compliance because sometimes errors in patient basic information lead to claim denials. These errors in patient details mostly erupt when medical coding services left any gap during coding. Therefore, the procedure in this phase is carry out very sensibly and carefully.
Step 5
The fifth step followed by the revenue cycle management company is the submission of the claim. Submission of claims is done electronically and manually. Most companies follow the procedure of submission electronically because according to HIPPA rules all insurance claims should be submitted electronically. However, some companies demand the manual submission of claims. Claims submission is the fifth phase in revenue cycle management companies. Besides this, the fifth step accommodates its users. It is the responsibility of coding services to send the properly coded claim to the payer.
Otherwise, claim rejections are occurred. When the charge capture process is completed. By tracking claims in real-time and stopping those in their tracks before insurance companies have a chance to be denied. Revenue cycle management companies also sort out these issues with the help of practice management software. Doing this, revenue cycle management companies are confident the company is filing clean claims at a rate of up to 99% and getting paid as soon as is practical. Hospitals and physicians automate this process by outsourcing revenue cycle companies. Who makes use of an appropriate practice management technology to complete their claim submission.
Step 6
After submitting a claim to the insurance company, the insurance company follows the revenue cycle management procedure. The insurance provider calculates their financial obligation for the provider’s payment following the submission of a medical claim. Adjudication of claims is the name give to this process. A claim approval is depend on the company procedure, denied, or the amount paid to the provider reduced by the insurance company. An insurance provider decide to lower a provider payment. which denotes a level of treatment whose cost is incompatible with diagnostic or procedure codes Therefore, it’s crucial to guarantee all claims file for payment are appropriately code.
Step 7
Insurance companies process claims and notify the biller of the claim’s acceptance or rejection. If the claim is valid, the medical biller in revenue cycle management prepares a statement for the patient. The statement posses information regarding the details of the amount that is claim. The insurance provider pays the provider according to the patient’s eligibility when the claim has been authorize. The provider is responsible for contacting the patient to obtain any outstanding payments if there is any balance after insurance reimbursement. By using optimizing the claims processing method, revenue cycle management company control hurries up this patient charge method.
Step 8
The collection of bills or payments from the patient is the final stage required for completing the procedure of a revenue cycle management company. From processing the medical data to generating and submitting claims. . To improving patient payments and putting a patient on the path to financial recovery from medical service charges revenue cycle management help both, the medical center and their patient. This stage should also incorporate high-quality collections services from the revenue cycle management service provider. The last procedure in revenue cycle management companies collects the bills for hospitals and healthcare offices for rendering their services.
Conclusion
The whole universe follows steps, rules, and procedures to accomplish its tasks. After all, revenue cycle management is a corporate function. Without any proper procedure, no one could run a business or any job. So, revenue cycle management also performs the steps to fulfill the necessities of its users. Revenue cycle management companies are the main connection between insurance providers, billers, and medical centers. This procedure called a cycle. Because there are detailed steps that collectively complete the revenue cycle management companies procedure. From entering patient details, in medical terms, and arranging appointment schedules to clearing medical bills revenue cycle management companies process each detail of a patient to accommodate hospital and healthcare providers.
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