Revenue cycle management is an integral part of medical billing services. Every company has its own process of catering to claims, but for effective revenue cycle management, certain steps must be in order.
These steps when are performed systematically enhance the performance of your revenue cycle.
The process of medical billing and coding starts with patient registration.
The front desk staff takes the necessary data and information from the patient to set an appointment for the doctor before the treatment. As soon as the patient registers with the physician, medical billing companies take their medical record to cleanly create the claim.
Moreover, professional medical billers ensure the accuracy of the information provided in the first step.
Patient check-in and checkout are an integral part of the patient registration process. To be precise, the front desk staff hands over a form to the patient for the information collection. Even if the medical billing staff has the information, they confirm the relevant information via the passport or the driver’s license to verify the patient’s identification.
Once the patient checks out (after the appointment), the information and the rendered services are compiled as a superbill. The actual medical billing and coding process starts from here.
Insurance Verification by the Medical Billing Service
In this step, outsourcing medical billing services verify the patient’s insurance completely. They thoroughly analyze the healthcare plan to check eligibility and policies’ compliance.
After the verification process, billing experts also check patients’ responsibilities such as, deductibles, copayments, and out-of-pocket expenses that they have to bear.
In some cases, prior authorization is necessary from the insurance companies before the service is rendered. It also takes place in this step. Most medical billing services use digital mediums to store and verify the information.
Recording of Patient’s Encounter
The team records or documents physician-patient encounters to keep a record of the patient’s health condition. It helps medical billers and coders to bill and code the performed services for accurate claims.
Medical transcriptions refer to the documentation of transferring video or audio of the patient’s encounter with a physician in an appropriate billing format.
After the billing company receives all the necessary information, they start with the actual billing of the services. The accuracy of information is always regarded, and outsourcing medical billing companies also ensure HIPAA-compliant billing services.
As obvious, now is the time to assign medical codes to medical transcriptions.
The process is to simplify the billing process as it is hectic for payers to read the complete medical history of patients. Therefore, medical coding is important and saves time.
Only experienced coders can code who are familiar with the CPT (Current Procedural Terminology) codes, and ICD 10 codes.
Charge Entry/Medical Billing
Before sending claims to insurance companies, it is important to bill rendered services in proper order. The team also monitors the patients’ records to rectify any errors. In case of any error, insurance companies deny claims or simply reject them, which dent the revenue cycle and increase the rate of accounts receivable (AR).
It is the step in which billing companies submit claims to payers either government or private via EDI (Electronic Data Interchange). They take extra measures to compile clean claims when sent through EDI.
There come three situations in cases of claims with errors.
Mandatory fields are to be filled, otherwise, the system rejects the claim – a process known as scrubbing.
The system rejects the claims with invalid information.
The system also rejects claims that are not as per the payers’ policies.
Here, the billing teams have to double-check every measure to avoid any leakage of secret information.
Accounts Receivable Management
The AR calling team checks up on every claim after its submission to respective insurance companies. The purpose of this step is to ensure payment posting in an efficient manner. This team is also responsible for sharing any additional information like account details and helps remove errors in claims.
They also correspond with the physicians, patients, and insurance companies and inform them about any updates.
This step caters to denied claims by the insurance companies. Sometimes, some claims have errors and are not up to the mark. Denied claim management deals with such issues. Constant follow-up services are part of denial management that timely acknowledges errors, rectifies them, and reimburses physicians.
Follow-up services, being part of the denial management, keep track of the claim performance. It is to maximize the reimbursement rate. Ultimately, no claim goes to waste over minor issues.
When medical billing services submit claims to payers, the follow-up team analyzes the processing of claims systematically. They are responsible to segment denied claims with the accepted ones and communicating with stakeholders (insurance companies, patients, clearinghouses, and more).
This is the end of the medical billing and coding process that helps the team to stay updated about the payment situation.
Concerned patients have the shared EOB (Explanation of Benefits) and ERA (Electronic Remittance Advice). The Payment Posting team also checks if the received payment is accurate.
These ten steps describe the complete process of medical billing services and are crucial to keeping the revenue cycle running smoothly. For more information, visit our website – www.p3care.com