What is RCM in medical billing?

Answer 1

Revenue Cycle Management (RCM) in medical billing refers to the process of identifying, collecting and managing the practice’s revenue from payers based on the services provided.Basically a successful RCM process is very much important for a healthcare organisation to continue to provide quality health care for their patients and also to maintain their financial viability.

The revenue cycle management process:

The revenue cycle begins when the patient makes the appointment and ends successfully if a payment is done correctly. But there are numerous steps in between this process to ensure timely payment.

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Answer 2

What are the steps in the medical billing revenue cycle?

The medical billing revenue cycle is a process that a doctor has to go through to get paid by a patient or insurance company. Medical billing revenue steps could be described with different steps of which mhrcm follow ten main steps as follows:

Step 1: Scheduling

Scheduling is the process which involves the process of appointments with the physicians for the patients. This includes the date and time of the appointment, duration of the appointment with the chosen health care facility or the hospital. It also includes follow-up appointments for the existing patients. The process gets initiated with this procedure in medical billing cycle management

Step 2: pre-registration

Though in some places this process is done by medical coders directly, the pre-registration for a patient is a mandatory process in the medical billing cycle. It gets started from collecting pre-registration information including the insurance coverages, plans, claim forms, inpatient, and outpatient procedures and so on.

Step 3: Registration

The registration process includes the patient’s detail collection. If you are receiving an existing customer with another provider, then get the data to be found with their previous provider. So, the details are to be edited and could be used for the current registration.

Step 4: Root cause analysis and follow-up

Root cause analysis is a mandatory procedure which we do to establish an understanding about the problem of the patients. This also includes the root cause of the problem for the patient and the follow-records of that patient with its history.

Step 5: Charge entry and capture (Revenue integrity)

Charge entry and capture that is also described as revenue integrity is a holistic encapsulation that involves legal and contractual compliance. The main purpose of integrity is to transform a patient’s experience into revenue in a health care organization by eliminating revenue leakage and other compliance issues.

Step 6: Claim submission

Once the process of entry and analysis is done. Then the next step is to submit the claim submission. This step of medical insurance claim submission is one of the key procedures in the cycle. This process ensures the reimbursement that our company receives after the claim is fully cleared by the insurance company.

Step 7: Claim submission reviews

Reviewing is an important aspect after the claiming process to make sure there are no errors. An error free claim could be left for the next process.

Step 8: Insurance follow-up

Insurance follow-up takes around a duration of 7 to 10 days (about 1 and a half weeks) after which the claim would be filled out and the denied claims would be re-opened and will be enquired about the payments.

Step 9: Denial management

Denial management is also described with the term rejection management. Rejected payments are payments which are left unclear from the payers for their paid claims. The denied payments should be clearly reassured with the correctness of the data and finally to make a re-submission of the same.

Step 10: Reporting

Reporting is the final procedure in medical billing that involves tracking claims, confirmation about the payments received, denials management records, and estimating our revenue from the claim.

We in MHRCM follow these steps to efficiently manage the revenue cycle of the management through the medical billing processes and other essential services for our clients.