The healthcare sector relies heavily on revenue cycle management (RCM). It is a compelling way to manage finances and administrative information since it combines all these aspects with the treatment the patient receives. RCM is more a process than a product and does not replace high-quality healthcare.
What is RCM?
Revenue Cycle Management is a financial mechanism that uses billing software to monitor patient treatment incidents from registration, and appointment to final payment. It involves a medical billing program.
Here are some crucial steps in revenue cycle management.
1. Outsourcing Medical Billing services or installing RCM software
The first step to the cycle is to decide how to manage your processing. You might prefer to install RCM software on your server if you are somewhat limited in scope or an excellent information team that can handle specialized medical billing software.
Larger companies, such as those with regional offices, usually find an outsourcing RCM process a better approach. Practices with minimal staffing experience in RCM would also profit from outsourcing to focus on their core patient care roles.
2. Pre-authorization of patients
Payers or insurance companies determine whether prescription drugs, treatments, services, or equipment are necessary. The pre-authorization decision determines the reimbursements. In the case of a medical emergency, there are exceptions to the pre-authorization stage.
3. Insurance Eligibility and Verification
The phase requires a lot of patience because a set function must be part of RCM software to accommodate it. In this recognition phase, artificial intelligence may play a pioneering role, since it automates the function
4. File Claims
Submission of claims is an essential stage in the overall process, as reimbursements will depend on it. If the presentation is erroneous, there will be higher chances of reduced payments or total refusals.
The biller files the claims and submits them to the insurance company through the clearinghouse. A clearinghouse ensures that they are safe and not fraudulent. Considering these allegations, the billing firm shall follow up with the insurance company. It will offer timely reimbursements to the payer.
5. Payment Posting
Once a claim has been approved, the payment is posted and can be paid by your patient. RCM Software can help here because it can conveniently generate billing statements.
6. Managing Denied Claims
In the case of denied claims, they will be re-submitted after verification of coding errors. A vital finger on the pulse of the newest code directives is essential for resubmission or appeal procedure. Also, the patient profile details are checked, and the billers deal directly with the payers.
If payers are paying less that means that the insurance program does not cover all programs. The billers then have a responsibility to submit the remaining payments to the patient and to follow up. Medical billing systems carry out strict tracking before the customer completes the payment.
All these essential steps ensure the streamlining of the dynamic process of revenue cycle management. Doctors need a competent team to execute these stages successfully.