As far as medical billing and coding service is concerned, the best way to attain higher revenue cycle management starts with checking for the eligibility of the patient, and goes on till the revenue is recovered from the denied or delayed claims.
Here are some crucial ways to attain higher RCM numbers:
Eligibility Verification
Inspecting the eligibility verification of the patient’s insurance coverage is where things start to roll. The Medicare coverage may differ from plan to plan, and this has to be confirmed with care to certify patient or the doctor is not troubled with erroneous data.
Streamline Coding
The most complex part to attain higher RCM numbers is via streamlined coding, and sticking to the Current Procedural Terminology (CPT). Coding by a doctor with his/her staff leads hours of time that could be utilized in attending patients. However, coding done by professional billers or by a third party organization can rule out surplus of errors, and ensure billing process is smoother.
Charge entry and Demographics
Entering all information of the patient, and the charges for the applicable services can be easily carried by experienced medical billing professionals. Patients who have come might not have been charged, sometime the ancillary services go missing from the list, and a few ordered services get omitted, all this can lead to a disastrous income cycle, and revenue leakage.
Payment Posting
This is the critical step which actually deals with the payment process. The claims get delivered to the insurance companies and based on the patient’s coverage policy. The charges received should be entered in the software for a higher RCM number.
Collections are vital
This process begins even before the claims are submitted. This is where the task of performing the eligibility check helps. This can prevent any further delay. Any patient who has a due amount that includes the deductibles, must be mentioned clearly.
Managing Denials
Recognizing the reason of denial can help a lot to collect the outstanding faster. Finding the faulty codes, the main reason for denial is something that can help in processing the claim faster. Keep in mind that the CPT codes cannot be changed and managing denials is half the success in preventing revenue leakage.
Managing Account Receivables
Following up with mails and calls to ensure payment is collected is a tough undertaking. Not just denials, but the claims that are pending for payment also need timely follow ups.
When you as a medical practitioner want your claims to be successfully reimbursed, every step of the RCM process is critical. Underestimating any of these can may lead to aged claims getting piled up for various reasons, and you not receiving the payment.
