If you believe that profit lies in adequate process of Medical Billing in RCM, well ! won’t disagree.

Every company follows own procedure or a process that makes their firm profitable. Likewise, medical billing companies also follow a unique process to stay righteous and commercial in the market.

Revenue cycle Management maintains a process which challenges all the denials and does payment posting at the right time.

The ten steps in the process of Medical billing are as follows:

  1. Patient registration
  2. Insurance verification
  3. Encounter
  4. Medical transcription
  5. Medical coding
  6. Charge entry
  7. Charge transmission
  8. AR calling
  9. Denial management
  10. Payment posting.
  1. Patient Registration:

  • Data or the information which includes insurance verification is detailed in a format to process the claim for the services rendered by healthcare.
  • RCM  company holds a strong grip on patient’s record in order to support flawless billing.
  • The above method applies only for the new appointment. The information of the old appointments will be already saved.
  • It gives medical billers a chance to verify with details provided before claim submission.
  1. Insurance verification:

  • Medical billing team verifies the patient’s insurance strictly end to end.
  • Eligibility and policy benefits are thoroughly focused.
  • It makes a clear note if the insurance claim can be obtained for the services rendered.
  • It checks the patient responsibilities such as co-pay, deductible and out of pocket whether patient had accumulated the expenses.
  • Under certain services, prior authorization is required from insurance company, if not service is ready to be provided.
  • The staff uses software system to verify the patient’s data in order to speed up the work.
  1. Encounter:

  • When patient consults healthcare provider, the details of the condition and service performed is recorded either by audio or video.
  • These particulars may be recorded in front of the patient or after the encounter.
  • It gives a clarity about the condition and medications that healthcare provider had prescribed.
  • They submit the record to the RCM company to process medical billing and claim the revenue.

  1. Medical Transcription:

  • Recorded audio or video is transferred into a medical script. The script contains complete condition of the health record.
  • The process of transferring voice-recorded or video-recorded medical reports by healthcare providers is termed as medical transcription.
  • Maintaining a formatted and edited file is important. Make sure the transcription does not hold any false or wrong data as it might put patient’s health at risk.
  1. Medical Coding:

  • The transcripted information is converted into medical codes for easy and time-saving procedure.
  • The transformation of patient’s condition, medical services, medical prescription into medical codes is called medical coding.
  • Reading the complete medical history of the patient consumes more time. So, it’s scripted into codes.
  • Only the medical team is involved in medical coding. They ought to have experienced and skilled in particular areas of medical coding.
  • Coders rely on DX (condition of the patient), CPT (service rendered to the patient) to transcript the medical record into medical coding.
  1. Charge entry:

  • Charges for the services rendered are specifically entered in the sheet before claiming from insurance company.
  • Patient’s medical records are clearly monitored and charged with an appropriate value.
  • The charges entered will be claimed by the medical billing company with insurance for reimbursement.
  • Charge entry sheet must contain no errors or else it may reflect during a claim.
  • For easy revenue claims and payment posting, accurate entry is necessary.
  1. Charge Transmission:

  • Transmitting the claims with accurate coding through EDI (Electronic Data Interchange) to the insurance company is called Charge transmission.
  • Only clean claims without errors will be transmitted through EDI.
  • Errors in transmission carry three levels:
  1. Scrubbing- Mandatory fields has to be filled without any mistake. Otherwise, the software would reject the claim.
  2. EDI rejection- Invalid information held in the patient’s record will cause claim rejection by EDI.
  3. Payer rejections- Rejection in claims occur according to the insurance guidelines and payer details.
  • Denials or payments are processed only after these three levels.
  • Medical billing claims follow a secured and encrypted transmission process.
  1. AR Calling:

  • AR caller concentrates on lower denials and increase payment flow in Revenue Cycle Management.
  • Their timely follow up with insurance company increases payment receivals.
  • AR caller’s main focus is to ensure payment posting for the services rendered by healthcare providers.
  • They hold a responsibility in sharing accurate details or information of patient and rectify if any errors found.
  • Correspondence and return mails from insurance and patient.
  1. Denial Management:

  • Denial management is an important key factor in Revenue Cycle Management.
  • It motivates a profitable revenue growth by reducing the denials with insurance company.
  • Addressing the denied claims on various issues and maintain constant follow-up.
  • Taking appropriate actions to decrease denials and increase revenue payments.
  • Determine the causes for denials and to reduce the risk of future denials.
  • Each denied claim is analyzed and researched by denial management team for best course of action.
  • Quicker payments for the denied claims within short period of time.
  • Prioritize denied claims based on payer, amount and others to ensure maximum reimbursements.
  1. Payment Posting:

  • Role of payment posting team is to ensure frequent payment posting to the patients without facing denials.
  • EOB (Explanation of benefits), correspondence, ERA (Electronic remittance advice) received from the insurance will be posted to concerned patient claims.
  • Denials and payments are captured by the posting team with EOB or correspondence receivables from insurance companies.
  • It’s important for the posting team to match the bulk payment receivables in order to tally with the cheque amount.
  • With the reference to the payment posted to the practice accounts including patient and insurance revenue will be calculated.

These ten steps help the medical billing in Revenue Cycle Management to next level by maintaining constant revenue growth and accessing numerous medical claims with no errors and less denials.