A well-organized practice require proper financial resources to make sure not only the delivery of medical services to the patients but payment to the providers and support staff, and also payment of overheads.
Importance of Revenue Cycle Management in Medical Practice
Any practice can streamline their tasks and allow practice to run smoothly with the help of revenue cycle management. Medical practice management software required to automate key functions in RCM such as scheduling, medical billing and coding, claims submission to insurance companies and report of collected payments.
Medical practices such as solo providers, group providers and hospitals etc. reply on proper reimbursement for the healthcare services that are provided to patients. Documentation is the key in the revenue cycle as the medical practice will only be paid from the insurance companies if the medical details and bills are properly processed.
Steps to Follow in Medical Billing
Very first and foremost step is to list the patient details, such as his/her age, gender, address details, and contact number. Insurance related information is also important while listing details.
The demographic and insurance details must be noted and should be revised/added if the patient regularly visits the medical practice. Nowadays most practices use advanced medical practice management software where patient details are entered only once, and patients do not have to go through the trouble of giving information every time they visit the hospital or clinic.
Eligibility and Verification
Every patient’s insurance information and eligibility information needs to verify before date of service. Insurance information may change at given time, which may require patient interaction to provide insurance details before his/her visit to provider. The status of insurance is also asked, and only active insurance plans would be processed, and if the mentioned medical services are covered or not; otherwise, the patient has to make a payment out of pocket. Any changes in the insurance plan or policy impact the patient’s authorization information and benefit.
Accurate coding of claims is very important for providing information to insurance payer of what exactly the patient is being treated for as well as the method of treatment the patient is undergoing. Every practice should use correct CPT codes to describe the patient’s symptoms or illnesses. This practice will help to reduce denials and boost practice collection.
The expenses incurred to render the service is added to the amount that is calculated by the medical coder. This is the first step in preparing the claim form that is submitted to the insurance company, and without a definite and accurate amount, the payment cannot be collected. The claim form is thoroughly checked to ensure the right amount is quoted as it resulted in either reduced payment or claim rejection altogether.
Once the claim completed, it must be send to insurance for the further process to receive reimbursement. Medical billers need to have access to the information they need about the insurance payer since there are so many variables for each insurance payer in determining how and when to submit a claim.
Claim Denial Management and Account Receivable
The insurance company only processes the claims that are received within a specified time limit. Insurance companies deny claims with errors. The claims denied even after corrections are followed rigorously with the insurance company, and further information is gathered that caused a denial of payment. The Insurance Coding, Medical Coding, and Charge Posting are shared to see for any errors. Account receivables team has to take care of claim denied reasons and the list of trend or rejection issues to prevent future claim denials.
Once insurance company verify the claim and decided to pay the claim, then either insurance company pay through a physical check or electronic fund transfer. Providers also receive explanation of benefits (EOB) for the payment made by insurance company. The professional team at a medical practice should all the details about the payment into the practice management system to prepare a collection report.
Our team is trained and certified, knows how to straightened out medical billing process for any medical practice and solutions according to requirement of particular medical practice and then connecting it with specific insurance company.