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What exactly is Revenue Cycle Management in Healthcare?

Revenue Cycle Management (RCM) is the financial process of utilizing medical billing software that healthcare facilities use to track patient care records. It is done from registration and appointment scheduling to the final payment of a balance.

Communicating with health insurance companies is a key component of Revenue Cycle Management. This article will discuss the steps of revenue cycle management.

 Steps of Revenue Cycle

The seven steps include pre-registration, registration, charge capture, claim submission, remittance processing, insurance follow-up, and patient collections.

  • Preregistration

This is the first and most important stage in the whole process. It allows the medical practice to capture demographic information and insurance details of the patient often while the patient is on the phone.

This information goes to the patient’s insurer and flows through the provider’s practice management system. It tells the patient’s coverage deductible, co-insurance, and co-payment.

In this step, financial expectations of the patient can be discussed including time of payment.

  1. Registration

This ensures the patient’s information is 100% accurate. Here, the provider collects co-payments and if it is a specialist, they will ensure a referral is in place to treat the patient. If this step is missed, they likely will not get paid for that service in the end.

 

  1. Charge Capture

This can be done in different ways. It can be automated where the information automatically flows into the practice management billing side based on what the provider puts in the documentation.

The other is the old-fashioned way, where front desk staff enter information and send it to billing where it’s keyed manually.

  1. Claim Submission

This is done after medical treatment has been provided to the patient. This includes sending information to the insurance of the carrier charges that have been incurred. This is done to cover what the patient is not responsible for so far. 

The revenue cycle team will look at the charges, CPT code, and diagnosis code. If a claim gets to the insurance carrier clean, it will get paid faster.

  1. Remittance Processing

Once the practice’s claims have gone out, they will get remittances back. Allowable is determined and the insurance company confirms how much they will pay for each service.

  1. Insurance Follow-up

The practice looks for what has and has not been paid for.

  1. Patient Payment Collections

This is the most difficult part. This is the process of managing patient balances and providing payment options. It can range from one-time payment in full to automated payment plans and patient financing. 

Patients paying through an online payment portal based on a hospital’s billing policy is crucial to maximizing revenue.

The best time to get money from a patient is when they are in the office.

  1. Reporting

With robust reporting tools, there is the utilization of medical services and accounts receivable.

It is evident that revenue cycle management is a very effective process that healthcare providers should adopt. Patients should also embrace the process for its efficiency.

 

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