The Absolute Guide to Smooth Revenue Cycle Management In Medical Billing

In times when insurance claim denials are skyrocketing, the only resort for practices and hospitals is to master their revenue cycle. Revenue cycle management in healthcare is a closely knit system that ensures that every claim you submit is met by payment. As crucial as the revenue cycle is, it isn’t just limited to submitting claims and waiting for reimbursement. RCM cycle in medical billing is a multistep process that starts when a patient registers themself and ends at the final payment. Read along for a step-by-step analysis of revenue cycle management.

1. Patient Registration: 

When a new patient visits or contacts a facility for an appointment, they collect all the documents and information related to the patient that could be required for insurance verification. This information is then analyzed and drafted in a format used to acquire information about all the health insurance plans and benefits that the patient can avail of. This step can be skipped if it is an old patient since you will already have all the required documents.

2. Medical Insurance Eligibility Verification:

All the information collected in the above step is used to determine whether or not the services being sought by the patient are covered in the insurance plan they are registered for. Also, this helps us gain insight into what part of the payment shall be done by the patient and what part shall be covered by the insurance company.

3. Medical Transcription:

On the day of the appointment, after the patient has received the services, we record the procedures performed on them. These are then transcripted into a script that contains all the details about the medical condition of the patient, the services provided to them, and the prescriptions. This record is then forwarded to the medical billing company, to help them submit claims.

4. Medical Coding:

The details mentioned in the medical report of the patient, about their medical condition and the treatment offered for it, are translated into codes. These make it easier to convey the medical report of the patient. This step has to be taken care of by the medical staff only.

5. Charge Entry and Transmission:

Charges for all the services rendered to the patient are mentioned in the sheet. It must be ensured that no errors occur during charge entry, or it would reflect in the claim submission and lead to its denial.
We use Electronic Data Interchange (EDI) to transmit charges with the correct coding to the insurance company, as a part of the charge transmission process.

6. AR Calling:

The AR team keeps in regular contact with the insurance company and keeps taking follow-ups from them about the claim settlement. This is one of the key steps in medical revenue cycle management that takes the claims from submission to settlement.

7. Managing Claim Denials:

If some claims are denied after submission, in this stage, we work on them and analyze them to identify the mistakes. We resubmit them to walk them toward settlement and reduce the denial rate.

7. Payment Posting:

In the final step of the RCM cycle in medical billing, we mention all the amounts received by the insurance companies, the claims that were denied, and other information such as EOB, ERA, and correspondence posted to the patients to keep them updated.

Revenue cycle management in healthcare starts with collecting information and documents from your new patient. We then use this data to determine the benefits that can be availed by the patients from their insurance company and to confirm if the services sought by the patient will be covered under their insurance plan. On the day of the appointment, we record the procedures performed on the patient and then transcript them. The script will contain codes representing the medical condition and the services rendered. It will also contain the amount charged. This is submitted to the insurance company, and we take follow-ups from them until the reimbursement is made. If the claims are denied, we analyze them and work on them again. The final data is posted in the final step, and we also update the patients about EOB, ERA, and correspondence.

About Capline Healthcare Management

Capline Healthcare Management is a leading provider of Revenue Cycle Management services, in the USA. We offer you professional assistance from our experts who strive with you to streamline your cash flow, while taking care of your back office, from medical billing to pre authorisations.

The easy way for claim settlement:

Juggling between claim settlements and providing quality care to the patients, to a large extent, affects the quality of your work. Capline Healthcare Management offers medical billing services and takes care of each step right when the patient connects with you till the final payment is made.