Revenue cycle management is a financial process that helps generate revenue for a healthcare practice. It is one of the most critical aspects of the whole medical billing process and involves many important steps. Here in this blog, we’ll discuss those steps one by one in detail.
- RCM is a financial process that involves generating revenue for a healthcare practice after going through multiple medical billing steps.
- Many different steps are involved in the medical billing process.
- The most critical ones include denial management and payment posting.
- Patient registration is one of the most initial and complicated steps of the medical billing process.
- Insurance verification is carried out after determining the patient’s financial responsibility.
- It is difficult to manually read the patient’s history, so proper medical documentation is required.
What is Revenue Cycle Management?
It is a financial process that involves generating revenue for a healthcare practice after going through multiple medical billing steps. Many medical billing companies offer outsourced billing services to healthcare practices and individual or groups of physicians.
Steps of Medical Billing in Revenue Cycle Management Process
There are many different steps involved in the medical billing process. The most critical ones include denial management and payment posting. Let’s discuss them one by one in detail.
1. Patient Registration
Patient registration is one of the most initial steps of the medical billing process. It is often considered a complicated step as it requires an ample amount of preliminary patient data to process the claim submission. It includes the name of the patient, birth information, and reason to visit your healthcare practice. For an accurate and error-free medical billing process, this step needs a considerable amount of attention. This information is crucial for medical billers as it helps them verify the patient’s insurance information.
2. Insurance Verification
Insurance verification in medical billing is when the patient’s healthcare benefits are verified to carry out the other mandatory steps. If your company or healthcare practice is unable to verify it, you probably have to manage unpaid claims at the end on your own.
This step is carried out after determining the patient’s financial responsibility. This step is essential as we need to find out the procedures covered by the insurance company.
3. Medical Billing Encounter
A medical billing encounter is subjected at the time of the patient’s appointment scheduling. It involves a detailed list of the services performed by the healthcare provider to the patient. This record is then submitted to the RCM team to process the claim submission further.
4. Medical Transcription
The medical encounter’s audio or video is then transformed into a script form. This script gives a detailed report of the patient’s medical condition. The transcribed audio or video is then saved for future use. Any editing in this file may put the patient’s health at risk.
5. Medical Coding
It is a relatively time-saving process. The patient’s services, procedures, or conditions are transcribed into medical codes. It is difficult to manually read the patient’s history, so proper medical documentation is of prime importance.
6. Charge Entry & Billing
After assigning medical codes, the next step in the medical billing cycle is charge entry. This step is considered an important one as the charges entered will help determine healthcare services reimbursement. It will ultimately help in generating a healthy revenue cycle for your medical practice.
7. Claim Submission
In this step, a healthcare provider submits claims to healthcare insurance companies and does a follow-up to ensure the receivables are collected after the patient has availed of services or treatment.
8. Claim Rejection
Rejected or denied claims are the ones that possess coding errors, including mismatched services. Such claims fail to meet the requirements of the healthcare insurance companies.
9. Payment Posting
This step is of critical importance in the revenue management cycle as it involves the registration of payment into the billing software. It also helps in the identification of the payer’s problem.
10. Denial Management
It is a term that best describes the practice of managing the denied claims after following up with the health insurance companies. The first step in claim denial management is identifying where the problem is and then managing it accordingly.