Revenue cycle management has become a keystone in the healthcare industry as the healthcare market is evolving with new regulations, laws, and systems. In healthcare, Revenue cycle management (RCM) is the process that enables organizations to be paid for the provided services.
When a patient comes in, they undergo pre-authorization. The physician’s office pre-approves the patient of certain treatments and prescription drugs by this process.
INSURANCE ELIGIBILITY & VERIFICATION
The process is downright demotivating over the phone because it demands a lot of patience. Therefore, a set function must be a part of the revenue cycle management (RCM) software to cater to it.
ICD CODING AND CHARGE POSTING
When the patient checks in at the office, the visit transforms into a set of codes. There is a high probability of human error in these codes, which is why professional medical coders are the go-to people for it.
Submission of claims is the vital stage in the overall process because the reimbursement directly depends on it. If it is flawed, the chances for reduced payments or outright denials increase.
For the claims which suffer rejection, they are resubmitted soon after they are scrubbed for coding mistakes. The resubmissions or the process of appeals demands critical screening with a finger on the pulse of the latest coding guidelines.
When there is reduced reimbursement from the payers, it means the health plan does not cover all the services. So, the billers have to send those outstanding payments to the patient and follow-up.
REIMBURSEMENT FOR THE SERVICES RENDERED
It is time for the insurance company to pay up. The payers match the procedures with their charges under the coverage limit.
OUT OF POCKET (CO-PAYMENTS AND DEDUCTIBLES)
Every health plan comes with a deductible and a co-payment. Some have high and some have low deductibles.
❖ Cutting-edge technology
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❖ 100% HIPAA-HITECH compliance
❖ Strong denial management knowledge
❖ Real-time audits and custom reporting
❖ Expert handling of aging accounts receivable
❖ Turnaround time less than 48 hours max
❖ Reasonable service fees with no hidden cost