The RCM process begins with patient registration and verifying their insurance coverage. Once the patient receives care, the medical services provided are documented and coded accurately for billing purposes. These codes are then submitted to insurance companies for reimbursement. If the claim is denied, the RCM team works to identify the reason for the denial and resubmit the claim with the necessary corrections.
The RCM process also includes patient billing and collections. Patients are billed for the portion of their healthcare expenses that are not covered by insurance. It is important that the billing is accurate and timely to avoid patient confusion and delayed payments. The RCM team also works with patients to set up payment plans and ensures that all outstanding balances are collected.
The benefits of RCM services are numerous. By outsourcing RCM services, healthcare organizations can free up valuable resources to focus on patient care. RCM services also help ensure that claims are processed accurately and quickly, leading to faster reimbursements and improved cash flow. In addition, RCM services help reduce the risk of compliance violations and other legal issues related to medical billing.
2. Identifying the Root cause and determining the
nature of revenue loss
Medical group leaders ought to establish why they’re having
revenue loss and the data suggested in-depth knowledge to
research revenue cycle management processes to ascertain
wherever denials trends occur very often.
3. Categorization and Prioritization
Drilling down the selected insurance/payer, department or
medical practitioner, or service line and perceiving the
dollar amount impact of inefficient processes or errors in
these areas.
4. Registration information and data quality
It is wise to have an alert system to spot potential revenue
loss data, and quality problems and establish workflows to
correct errors in real-time. This increases its registration
accuracy from 90-99%
5. Eligibility
By boosting RCM staff training and utilizing analytics to
trace verification levels, these medical groups will execute
successful eligibility verifications between 25,000 and
30,000 verifications per month.
6. Pre-certification or Prior-Authorization and medical
necessity
The medical group staff should check authorization a
number of days before the procedure and on the day of
service.
