Revenue Cycle Management (RCM) is a crucial area for the healthcare industry, with numerous challenges thrown into this arena. Economic aspects can be shaken when the practices followed do not fetch profit, as required.
Revenue Cycle Management begins with checking for the eligibility of the patient, and extends till the revenue is recovered from the denied claims. A brief analysis of the best practice includes:
- Eligibility: Checking the eligibility of the patient’s coverage is where we start. Coverage can vary from plan to plan, and this has to be verified with care to ensure patient or the physician is not troubled with erroneous data.
- Coding: The most complex part of the RCM is coding, and we stick to the Current Procedural Terminology. Coding by a physician with his/her staff means that the hours of working can be brought down considerably. Coding done by experts by third party can rule out plethora of errors, and ensure billing process is smoother.
- Demographic and Charge Entry: Entering all data of the patient, and the charges for the relevant services is carried over by experienced billing professionals. Patients who have arrived might not have been charged, ancillary services go missing from the list, and a few ordered services might not be included in the list. Using electronic forms or automated systems can help in preventing revenue leakage.
- Payment Posting: This is the step that actually deals with the payment process. The claims reach the insurance companies or the patients, based on the coverage of the policy. The charges received are entered into the software.
- Collections: This process has to begin even before the claims are sent. This is where performing the eligibility check at the right time helps. When claims are not paid, it is essential to send the financial responsibility report to the due payer at the earliest is recommended. This can prevent any further delay. Any patient due amount or the responsibility of the patient, which includes the deductibles, must be mentioned clearly.
Prompt follow ups can ensure the dues are collected on time. This also allows collecting more outstanding balances, which is better compared with calling the same patient every time for reminders.
- Denial Management: Identifying the reason of denial can help a lot to collect the outstanding faster. Finding if the contractual adjustment or faulty codes is the reason for denial is what that can help in processing the claim to suit the needs. Of course, CPT codes cannot be altered, but the codes that are eligible for payment from the insurance can be pushed for processing. Managing denials is half success in preventing leakage of revenue.
- Account Receivables: Following up with calls and mails, ensure payment is collected in a hasty pace. Not only denials, even claims that are pending for payment need timely follow ups.
- Revenue Recovery: When Account Receivables of previous weeks or months are not followed on time, they get piled up. Eventually this means, no revenue is generated. Checking for apt reasons, which can include correcting the codes, correction of faulty data, and timely reminders, is essential. Implementation of corrective action is far more vital.
When you want your claims to be paid successfully, every step of the RCM process is crucial. Underestimating any of these can mean the claims getting aged and piled up for various reasons, and the payment getting withheld.
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