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11 Aug The 5 Most Important Steps to Follow in Healthcare Revenue Cycle Management (RCM)

Posted at 06:00h in Medical Billing by Landon Asbury
Medical RCM Guide
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5 Steps To Follow In Healthcare Revenue Cycle Management

Revenue Cycle Management (RCM) is one of the most crucial aspects in the healthcare industry. It is a process that ensures the financial health of a healthcare provider and its patients. The revenue cycle management process is designed to identify revenue opportunities, mitigate risks, and improve cash flow.

RCM is also important, because it helps enhance the patient experience and optimize profitability.

Steps in Healthcare Revenue Cycle Management

Healthcare revenue cycle management is a complicated process, but it doesn’t have to be. Here are five steps you can take to ensure your organization maximizes its revenue cycle management efforts and minimizes errors or delays.

Step 1

Verify Patient's Insurance Eligibility

Step 2

Obtain Pre-service Authorizations

Step 3

Charge Entry – Coding and Billing

Step 4

Claims Transmission / Adjudication & Follow-up

Step 5

Payment Posting, Reconciliation, and Reporting

Step 1: Verify Patient's Insurance Eligibility

Once you have identified the patient, it is important to verify their insurance eligibility. You can do this by checking with the patient if they have any insurance, and what type of insurance it is. If they are uninsured, you may check with their employer or family member for financial assistance options. You will want to verify that the insurance is active and covers the needed care, along with any associated costs (including hospital stays). This may require calling your billing department, as well as requesting information from other parties involved in processing claims, such as pharmacies or clinics that work directly with medical providers like doctors or hospitals.
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Step 2: Obtain Pre-service Authorizations

Pre-service authorizations are documents used by the patient's referring physician to indicate the type of procedure being performed. If you do not obtain pre-authorization, it may lead to delays in scheduling your services and ultimately put you out of compliance with your contract with payer companies.
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Step 3: Charge Entry – Coding and Billing

Charge entry is the process of assigning an appropriate code to a procedure performed by a healthcare provider. It's the first step in revenue cycle management, and can be done manually or through automation. A charge entry system is a software application that automates the process of assigning codes to procedures and services provided by healthcare providers. Charge entry systems are designed to be used in conjunction with EHRs, which automatically collect data about each patient visit. This data can then be exported from the EHR into the charge entry system using HL7 messages.
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Step 4: Claims Transmission / Adjudication & Follow-up

Claims Transmission and Follow-up is the process of submitting claims to the payer, following up on any denied claims, and ensuring the payer receives all necessary documentation. This step is often referred to as “submitting” or “transmitting” claims. It can also be called claim follow-up, claim management, and claim adjudication. The purpose of this step is to ensure that all claims have been submitted and processed correctly by an outside entity (i.e., a health insurance company).

Transmit claims to payer:
1. If your practice has a provider portal, you should be able to transmit the claim directly through it. Otherwise, submit claims electronically or mail them in so they can be processed as quickly as possible by either the payer or clearinghouse, depending on what method they prefer.

2. Schedule follow-up calls with patients who have outstanding balances on their accounts, especially if they are new to your practice and have not paid off any past bills before becoming patients. Follow up several times over the course of one month before sending out collections letters if necessary (more about this later). If you catch two follow-ups with a patient at once—one for an appointment reminder call and another for payment reminders—you'll save yourself some time by doing them together so there's less overlap between calls. This also reduces confusion among patients, who may think someone else has already called them about their payments, when it was just another reminder from you!

Patient responsibility:
After insurance adjudication, patient responsibility is assigned and the patient collection process begins by sending a patient statement. Outbound calling may be needed as well, if patients are not prompt with payments. as well as receiving inbound calls from patients to pay their portion or to provide updated insurance information.  
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Step 5: Payment Posting, Reconciliation, and Reporting

Payment posting, reconciliation, and reporting are the three core functions of any revenue cycle management system.

Payment posting:

This involves reconciling incoming claims against what was actually paid or denied. It is important to get this step right for accurate reporting. For example, if you deny a claim, but it still gets posted as paid (or vice versa), it can mess up your reports and make them inaccurate in terms of timeliness and accuracy.

Reconciliation:

Once all claims have been posted, they must be reconciled with the customer's account to ensure there are no discrepancies between what has been billed and what has been paid out by the patient/customer on their end. The process involves checking that all charges made by providers match those submitted by payers, so there are no over-charges or under-charges that need to be addressed before reporting can begin. If there are discrepancies found during this step then they must be resolved before proceeding forward with reporting, so as not to cause further confusion later on down the line if someone looked back at these reports after several months since the completion date (e..g., current year).

Reporting:

A crucial aspect of revenue cycle management has always been about communication between stakeholders within an organization such as physicians or hospitals who submit claims based upon services rendered; insurers such as Blue Cross Blue Shield which cover medical costs for policyholders under certain plans depending upon type of coverage purchased; third party administrators who manage accounts payable like MACs (Medical Assistance Contractors) in New York State--these individuals monitor all financial transactions
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Medusind Revenue Cycle Management Healthcare Services

As you can see, there are many steps involved in the revenue cycle management process. These are some of the most crucial aspects that healthcare providers must take care of so they get paid for the services they provide. Medusind provides RCM services at every step of your medical practice’s journey, from patient registration through billing and collections. This ensures that patients receive proper treatment, your staff gets paid on time, and your organization stays profitable!

Medusind is a leading revenue cycle management company in the healthcare industry. Medusind offers healthcare revenue cycle management services to hospitals and healthcare providers.

The healthcare industry is one of the largest industries in terms of revenue generation, but it’s also one of the costliest industries to operate in. This is why Medusind helps healthcare providers improve their cash flow by reducing bad debt and collecting payments from patients.

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See How Medusind Can Work for You

Tell us about your business or organization and we’ll connect you with a Medusind expert who can show you the products in depth, and answer any questions you have. See how a provider, office manager, or biller use Medusind to empower their practice.

See how Medusind can work for you

Tell us about your business or organization and we’ll connect you with a Medusind expert who can show you the products in depth, and answer any questions you have. See how a provider, office manager, or biller use Medusind to empower their practice.