The Main Components of Revenue Cycle Management
The demand for the efficient management of accounts receivables for medical practices has generated a huge market for services referred to as Revenue Cycle Management (RCM). RCM correctly handles the complex regulations that medical providers face to get paid for routine or critical healthcare providers. To ensure that there is cash flow in a sector where reimbursement is highly controlled, dentists and physicians should hire individuals with particular RCM skills. Efficient management of medical receivables is made possible through contracting qualified businesses. The big insurance providers and Medicare cater to the bulk of the healthcare in the States. The percent not paid for by the insurance companies is covered by patients. With the increased growth in high deductible health plan use, the balances paid for by the patients are going higher. Both these elements of account receivables have to be handled through a time-sensitive and extensive procedure.
Medical receivables management does not begin after a patient completes their visit or when the patient signs for a consultation. Effective RCM begins when the patient schedules an appointment and ends when the individual pays for any amount not paid for by the insurance companies.
There are the main components of RCM, and each is crucial to the cash flow of your medical clinic.
When the patient calls to make an appointment, the front desk should verify the insurance policy when the patient remains on the phone. They should request for co-pay amounts from the patients at the checkup before the patient ever sees the doctor. The insurance claim that has the right diagnoses and treatment processes is then submitted to the correct payer electronically through some known standards of submission. If there are any errors in the preparation of the claim or submission process, flagged claims should be submitted again when corrections are made.
When claims are paid, the main plaintiff that Is that the Insurance carrier will send a remittance information allowing the billers to post payments electronically and transfer any balances that are owed to a patient or secondary insurance coverage for prompt payment mechanically.
The key to efficient management of accounts receivables is to follow up on them. The providers have to inform the billing office of any partial payments, denied claims as well as claims that don’t have errors but are still outstanding after a specific time. By giving priority to these unpaid claims by the amount, payer, and reason, the representatives of the accounts receivables can review and get in touch with the patients and payers accordingly to request for payment or status.
After tracking the insurance payments and they are applied to the claim balance, the balances that remain are billed to the patient by printing the statements immediately.
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