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The cycle begins with the collection of patient information during pre-registration. This includes demographic details, insurance information, and any relevant financial data. Accurate and complete information at this stage is crucial for a smooth RCM process.
After pre-registration, appointments are scheduled, and the eligibility of the patient’s insurance coverage is verified. This step ensures that the provided services are covered, reducing the risk of claim denials.
During the patient visit, healthcare providers document the services rendered. This information is then translated into medical codes (such as CPT and ICD-10) for billing purposes. Accurate charge capture is essential to prevent revenue leakage.
Once the services are coded, claims are submitted to insurance companies for reimbursement. This step involves ensuring that all necessary documentation and coding are in compliance with the specific requirements of payers.
After claims are submitted, payments from insurance companies and patients are posted to the accounts. This step involves reconciling payments with the billed amounts and accounting for any adjustments, co-pays, or deductibles.
In cases where claims are denied, RCM includes a process of investigation, correction, and resubmission. Timely and accurate handling of denials is crucial to optimize revenue flow and prevent delays in reimbursement.
Unpaid balances are communicated to patients through billing statements. RCM includes a follow-up process to ensure that outstanding balances are addressed, and payment arrangements are made. Clear communication is essential for maintaining positive patient relationships.
Regular reporting and analysis of key performance indicators (KPIs) are integral to RCM. This step involves assessing the efficiency of the revenue cycle, identifying areas for improvement, and implementing strategies to enhance financial outcomes.
Stars Pro® Medical Billing inventive model is one of the fastest growing physician practice communities in the United States. We are dedicated to lashing change in the medical community by providing progressive, state-of-the-art solutions. Through our Channel Partnerships.
