The Primary Elements of Revenue Cycle Management

The demand for the Successful Management of Accounts Receivables for medical practices has generated a huge market for solutions known as Revenue Cycle Management (RCM). RCM rightly addresses the complicated regulations that medical providers face to get paid for critical or routine health care services. To ensure that there is cash flow in a sector where reimbursement is highly controlled, dentists and physicians should hire individuals with particular RCM skills. Efficient management of medical receivables is made possible through contracting competent companies. The large insurance providers and Medicare cater for the majority of the healthcare in the States. The percent not insured by the insurance firms is paid for by patients. With the increased growth in high deductible health plan use, the balances paid for by the patients are going higher. Both these elements of account receivables have to be handled through a time-sensitive and extensive procedure.

Medical receivables management doesn’t start after a patient finishes their visit or whenever the patient signs in for an appointment. Efficient RCM starts when the patient schedules an appointment and ends when the patient pays for any amount not paid for by the insurance companies.

There are the main parts of RCM, and each is vital to the cash flow of your medical practice.
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When the patient calls to make an appointment, the front desk should verify the insurance policy when the patient remains on the phone. They should ask for co-pay amounts from the patients at the check-in before the patient ever sees the doctor. The insurance policy claim that has the proper diagnoses and treatment processes is then submitted to the correct payer electronically through some known criteria of submission. If there are any errors in the preparation of the claim or submission process, flagged claims should be submitted again when corrections are made.
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When claims are paid, the main plaintiff that Is that the Insurance carrier will send a remittance information allowing the billers to post payments electronically and transfer any balances that are owed to a patient or secondary insurance coverage for prompt payment mechanically.

The key to efficient management of accounts receivables is to follow up on them. The suppliers should inform the billing office of any denied claims, partial payments, and even claims that do not have errors but are still outstanding after a particular time. By prioritizing these unpaid claims by the amount, payer and reason, the agents of the accounts receivable may examine and get in touch with the patients and payers accordingly to ask for payment or status.

After tracking the insurance premiums and they’re applied Into the claim balance, the balances that remain are charged to the patient by printing the statements as soon as possible.