Key Steps in the Revenue Cycle Management Process
Effective Revenue Cycle Management process consists of a series of steps that keep track of patient care episodes from pre-registration to the final payment of the balance to ensure that the healthcare providers receive prompt payments for the services provided. With the help of these steps, healthcare providers can maximize revenues by streamlining operations and decreasing claim denials. In this article, we will explore the key steps of Revenue Cycle Management process in more detail. Each step significantly ensures that healthcare providers or doctors are reimbursed precisely and effectively.
1. Patient Registration and Scheduling
The revenue cycle management starts with the appointment scheduled by the patient. This step is crucial as a little mistake can lead to future administrative errors. It is vital to accurately collect patient information like personal details, contact numbers, other information, and insurance-related data. Insurance details are necessary and crucial to check that the patient’s insurance is valid and will cover the scheduled service. The accurate information related to insurance coverage and the verification process prevent delays in future payments and claim denials.
Information to be gathered at this stage
- Name of patient
- Demographic details of the patient
- medical history pertinent to the patient or the purpose of the visit
- Information about insurance
- Details of billing
Importance of Patient Engagement and Data Accuracy
To avoid administrative errors and ensure accurate billing Patient engagement and patient data accuracy are important.
- Patient engagement: early engagement of the patient helps in collecting complete and error-free information
- Patient Data Accuracy: Patient data should be accurate, and effectively captured to avoid claim denials and billing errors.
2. Insurance verification and appointment Scheduling
Verifying insurance coverage and eligibility before the patient arrives for an appointment is very important for healthcare providers. This will help the caregivers to confirm that the specific medical service is covered in the patient’s insurance plan. And whether he is eligible for the scheduled service.
Data to collect at this stage:
- Insurance eligibility
- Insurance benefits
- Referrals and pre-authorizations
Verifying eligibility through these steps helps avoid future payments, claim denials, and unmet requirements. Healthcare providers must be aware of the patient’s insurance status.
3. Charge Capture
Charge capture is related to all billable services rendered to a patient. Accurate charge capture is mandatory to ensure there is no underbilling or missing service which can result in lost revenue. Charges for anticipated treatments for each patient must be recorded on a claim, which is then sent to the patient’s insurance provider or health plan. This is an important step that verifies the charges’ accuracy and the method by which your healthcare organization will be reimbursed in the end. After the charging process, the billing procedure starts. With the help of coded data healthcare providers generate claims which they send to the patient’s insurance company for payment. The precise and unambiguous claims reduce the possibility of rejected or declined claims.
4. Review and Coding
This action needs to be taken by the patient’s health plan or insurance provider. At this point, they review the scheduled services’ medical needs. You will receive the information back from the insurance provider when it has decided whether to pay for these services for this patient.
Procedures need to be coded into billable charges once the insurance provider has verified coverage and the procedure has occurred. Each procedure has a billing code, and coders are skilled at converting the patient’s treatment record’s documented procedures into these billable codes. Bills and claims for payment are subsequently generated for the patient using the codes.
5. Claim Submission
The next stage is to submit the prepared and coded claims to the payors, who are the patient’s insurance company or health plan. After reviewing the claim, the payor will check for any mistakes or discrepancies with the previously authorized methods. In this stage, it will be decided whether the claim will be denied or paid. Two important aspects in this stage are as follows
Key Aspects of Claim Submission
- Understand the reasons behind the rejection of the claim and how to address them
- Use technology to update claim submission and settlement.
6. Remittance processing and payment posting
Your information regarding the amount that will be compensated for the claim is sent to you by the payor after it has been processed. The claim payout may be delayed if inconsistencies or inaccuracies are found. Should mistakes be discovered, the claim must be resubmitted. You can charge the patient for any remaining patient responsibility amount by delaying the payor’s payment until after you resubmit. To make sure you are not missing any payments, you should regularly review your remittances.
Steps must be taken here
- To maintain cash flow delays in payment posting must be addressed
- Remittance must be reconciled with payments.
7. Patient billing and collection
After the payor has been paid, you need to figure out how much is still owed on the account and whether the patient still has any obligations. This is frequently one of the most difficult phases to finish for certain firms. It’s important to send out statements on time since the sooner you do so, the sooner you can expect payment. To collect payments from patients who still owe money, monitoring outstanding accounts is another aspect of collections. As patient deductibles rise, this step becomes even more crucial. The patient is bearing a greater portion of the cost of rendered services. Give the patient enough notice when payments are due by being transparent about your business’s fees and schedules.
Your healthcare organization’s success depends on how successfully you manage this cycle. You will see more patients and gather more data as your company expands. There is an increased risk of error and loss while handling a larger volume of data. Either you have a staff dedicated to revenue collection, or you have one individual doing this task alone, depending on the size of your firm. Securing reimbursement from patients and insurance for your important services is contingent upon your ability to pay attention to each phase in the medical revenue cycle management process.
