Healthcare providers need to maintain a balance between providing high-quality care and remaining profitable. It is essential for all providers, regardless of their size, to receive payments promptly from health insurance companies and patients to cover operational costs. Thus, revenue cycle management needs to be effective as it’s the life of a patient’s account from the first appointment till the provider receives payment.

For some providers, revenue cycle management (RCM) may be quite challenging because it competes with other administrative tasks. That’s why we will be discussing the stages in the process of RCM that your organization can follow to achieve better financial outcomes. 

1. Pre-Authorization

At this point, the provider collects the patient’s health insurance and billing information. During this phase, using automated verification tools to confirm eligibility makes the process more efficient. It allows the provider to know how they will receive payment for their services and alerts patients to their responsibility to make prompt payments.

To improve this stage of the process, providers should quote clear and transparent prices and use proper verification tools to confirm their patients’ insurance status.

2. Capturing of Services and Fees

The medical fees need to be captured as soon as the provider renders medical service to a patient. This process is known as charge capture. At this stage, the provider assigns a billing code to the insurance claim.

When a provider uses a well-designed medical billing application, the appropriate codes will be automatically entered into the claim. This eliminates the errors associated with coding and ensures that the claim is appropriately coded from the onset. The provider can potentially save thousands of dollars that would be lost to claim re-work due to incorrect coding.

3. Submit Claim to Payer

Once the claims are correctly coded, the next step is to submit them to the payer. Using a robust practice management solution can enhance the process of verifying and tracking claims. It is always better to review and verify claim details before submission. This reduces the likelihood of denial and ensures prompt payment.

To reduce the number of denied claims, providers can outsource their RCM and billing to a service provider. The RCM service provider will automate the claim verification and ensure that only clean and error-free claims get submitted for payment.

4. Receive Payment

After the patient’s insurance provider reviews the claim, the payer will pay the patient’s medical bill. Then the provider informs the patient about the costs that must be paid in cash.

With a robust practice management system, patients will receive payment notices through the patient portal. They can also make payments through the same interface.

Using patient portals to receive payments can increase the rate at which patients settle their bills. A report by a 500-physician medical group in New Jersey showed that they received 30% of their payments through their online patient portal.

5. Process Review

Ideally, the last stage of the RCM process is receiving payment from a patient. But providers also need tools to review the entire RCM process and discover the causes of denied claims, delayed payments, and other issues that can occur in the cycle. Providers can use quality assurance reporting tools integrated into their billing software to identify loopholes that need to be plugged for more efficient revenue cycle management.

Let Us Help You With Your Revenue Cycle Management

Connect with MediQuant to start collecting your bill payments promptly without unnecessary claim denials and delays. Call us now at 844.286.8683 to schedule a free consultation regarding your RCM needs.