![]() ![]() RCM systems can also save providers money by giving them insight into why claims have been denied. These duties include administrative tasks, such as informing patients of upcoming appointments, reminding payers and patients of an existing balance and reaching out to insurers with specific questions when a claim is denied. An effective RCM system can reduce the amount of time between providing a service and receiving payment by interacting with other health IT systems - such as electronic health record (EHR) and medical billing systems - as patients move through the care process.Īn RCM system can also save healthcare organizations time by automating duties that were previously handled by employees. Healthcare providers often purchase and deploy designated revenue cycle management systems to store and manage patients' billing records. However, it is more difficult to influence external factors, such as patient payments or claims reviews from insurance companies. Utilization review: Examining the necessity of medical services.Īs with any financial matters, there are internal and external factors that affect how revenue is collected.Ī healthcare organization can exert some control over internal dynamics, such as provider productivity, patient volume and fees for services.Third-party follow up: Collecting payments from third-party insurers.Remittance processing: Applying or rejecting payments through remittance processing.Registration: Collecting subsequent patient information during registration to establish a medical record number and meet various regulatory, financial and clinical requirements.Preregistration: Collecting preregistration information, such as insurance coverage, before a patient arrives for inpatient or outpatient procedures.Patient collections: Determining patient balances and collecting payments.Coding: Properly coding diagnoses and procedures.Claim submission: Submitting claims of billable fees to insurance companies.Charge capture: Rendering medical services into billable charges.Here is what's involved in the revenue cycle: The revenue cycle includes all the administrative and clinical functions that contribute to the capture, management and collection of patient service revenue, according to the Healthcare Financial Management Association (HFMA). The hospital or care facility then sends the care summary with ICD and Current Procedural Technology codes to the patient's insurance company to see what portion of the care will be covered by insurance, with the patient billed for the remainder. After an insured patient receives treatment for a given condition and supplies any applicable copayment, a healthcare provider or coder categorizes the nature of the treatment according to ICD-10 codes. When a patient schedules an appointment, the physician's office or the hospital staff typically check the patient's reported insurance coverage before the visit. ![]() RCM unifies the business and clinical sides of healthcare by coupling administrative data, such as a patient's name, insurance provider and other personal information, with the treatment a patient receives and their healthcare data.Ĭommunicating with health insurance companies is a key component of RCM. Revenue cycle management (RCM) is the financial process, utilizing medical billing software, that healthcare facilities use to track patient care episodes from registration and appointment scheduling to the final payment of a balance. ![]()
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