Steps of Medical Billing in Revenue Cycle Management
Medical billing companies make a profit by using a unique process that ensures flawless payment posting, minimal denials, and smooth revenue cycle management.
RCM Company manages the patient’s medical records to simplify flawless billing. It also considers all essential data, including insurance verification, and presents it in a format that facilitates the claim for medical services provided by healthcare.
The medical billing team verifies the patient’s insurance, considering the policy benefits and the patient’s eligibility. It provides a clear statement of whether the insurance claim is accessible for the services rendered. It also points out the patient’s responsibilities like co-pay, deductible, and other expenses beyond insurance scope.
During the patient’s consultation, the suggested line of treatment is recorded through audio or video. These details are recorded to clarify the patient’s condition and the medications prescribed by the health care provider. This record goes to the RCM Company and is used in processing medical bills and revenue claims.
A medical script holds all details of the health record, including the audio and video recording. This process of transferring video- or voice-recorded reports is called medical transcription. Transcription errors may be risky for the patient’s health.
Medical coding is the transformation of patient’s records into medical codes for convenient and quick processing. They include the patient’s condition, medical prescription, and treatment procedures provided to the patient. An experienced and skilled medical team is employed to perform medical coding. The group considers the DX (patient’s condition) and CPT (services provided to the patient) to transfer records into coding.
Costs of services provided to the patients are recorded in a sheet before sending them to the insurance company for the claim. Patient’s medical records are presented accurately, and an appropriate value is charged against them.
Claims are sent to the insurance company with accurate coding details via EDI (Electronic Data Interchange). EDI only allows error-free claims for transmission.
AR caller’s prime focus is posting payments for health care providers. They continually follow up with insurance companies to ensure smooth and timely payment receivables.
Denial management reduces the denials, resolves the issues that lead to contradictions, and increases revenue payments. An expert team reviews each denied claim, and action is taken to maximize reimbursement.
The payment posting team ensures timely payment posting to patients and avoids denials. ERA (Electronic Remittance Advice), correspondence, and EOB (Explanation of Benefits) are then assigned to the patients.
These ten fundamental steps make the medical billing in revenue cycle management generate revenue by assessing and controlling various medical claims, removing errors, and minimizing denials.