The Revenue Cycle Management process is a nitty-gritty procedure, but it is vital to ensure that your medical practice runs smoothly. It requires a keen eye for detail at each step to ensure that claims are error-free, and should this happen, the claim must undergo the process one time and this dramatically increases the time required for claims to be paid. However, a mistake could result in an unbalanced process of payment. This is why it’s crucial to collaborate with experts.
In order for every business to operate smoothly and continue to grow, it is essential to follow certain guidelines with the utmost care, and the medical billing process is not any different.\
Medical Billing Services For Small Practices
Here are 10 steps when followed correctly can result in better income generation.
It is generally done for new patients only. We collect patients’ personal details like age, gender address, phone number, and so on. Additionally, we collect information related to insurance like policy ID or name of insurance but we strongly suggest a quick scan each time a patient goes to the office. This allows us to keep accurate data and keep the system up-to-date with all the relevant information. it is recorded in the insurance claim and any error could result in the rejection or denial of the claim which could delay payment even more.
Checking for Insurance:
Prior to the services offered the insurance company must be notified whether the policy is in effect and covered services are available. Also, any authorization requirements aid in determining who is responsible for payment, whether it is insured or the patient has to pay out of their own pockets. Most insurance websites offer this information, however, the information gathered during the phone calls could later be used to defend claims in the event of any denied claims.
The term “encounter” is used to describe meetings between patients and the provider, in which the patient describes the issue and the doctor evaluates the condition of the patient in order to determine if it can help the patient to cure. The session is recorded using either video or audio technology. Ensuring that the details are recorded accurately and that the session is recorded properly and analyzed, claims can be flawlessly recorded.
Medical professionals listen to recordings and then record the details into a medical document, then used to create and maintain the health records of patients. It must be a procedure that is error-free, as the documents which have been revised are later used for subsequent follow-ups. A doctor will refer to these documents in order for care, and any inaccurate information could compromise the patient’s medical history and lead to faulty medical decision-making. Additionally, it is used to bill the patient, therefore if there’s any incorrect information, it could affect the claim as well. Go to the website to learn how our medical billing services can help you and all your staff reduce errors in medical billing and increase insurance reimbursements.
In accordance with the guidelines of the American Medical Association a team of medical professionals will read the report created from the recorded information and then convert the relevant information such as what was the place where the service was provided as well as the purpose of the visit, the measures the doctor take to treat the condition, etc. into codes that are either alphanumeric or numeric. This is necessary because they are simple to read and secondly, it’s an obligation.
The amount of money for providing this service or the most reimbursable sum is later added to charges that are coded by the coding team. This is one of the steps needed to complete the claim form to be provided to the insurance firm, without the value that is specified, it is impossible to receive the reimbursement for it. Professionals oversee the system to ensure that the correct amount is entered since an error could result in a reduction in the amount of the claim.
Once you have succeeded in making the claim, with the help of patient information and provider information, as well as the services rendered, etc., the claim is now ready to submit to be reimbursed. Technology has enabled us to transfer data electronically. When claims are made through EDI (Electronic data transfer) there are three levels which claims must meet to be accepted by the insurance company, following are the steps:
An. Scrubbing EHR services performs a check to make sure that all claims form fields are completed and, based on the configuration, it checks for specific coding-related issues.
A third-party provider responsible for EDI conducts checks on the information of the patient such as the current dates of insurance, name, and DOB of the claim, and possible code mistakes.
Rejection by Insurance
Prior to accepting the claim as adjudicated, insurance will conduct a quick review similar to clearing house checks to verify that patient information is accurate, the policy is in place and there isn’t any general code error. If the claim is rejected due to any error or mistake found in either of these levels, claims are rejected, and they will be returned. Checks and corrections that can be made in light of the information supplied could help the claim get through these hurdles.
In the event of a denial, insurance will take care of claims that are received within their specific time frame. After acceptance, they put the claim through an adjudication process, also known as adjudication. Using specific checks to the claim. They decide if they want to settle the claim or deny it, at times, they pay a portion of the claim but deny the remainder of the costs. Professional handling prioritizes the claim based on the time remaining to submit the claim to insurance as well as the remaining amount to be recouped, ensuring maximum revenue production. They keep track of denials in order to spot trends in denial and then take steps to correct the issue so that future claims are not denied.
Accounting Receivables experts manage claims that are denied by insurance companies and not getting paid even after corrective steps were implemented to pay the claim. They are focused on following up with insurance companies who collect details about the denied claim and investigating and coordinating in order to keep the payments. They also are accountable for managing and maintaining the in- and out communication with the insurance company.
When the insurance company has decided to pay the claim they make the payment available by way of a paper check or an electronic fund transfer, which are usually bulk payments, and, along with it, they provide a summary, which is called EOB (Explanation of Benefits) (EOB) also known as electronic Remittance Advice (ERA). Professionals who handle the payment are required to enter the information into the EHR and add up the amount received.
Medcare MSO offers all of this and many more at affordable costs for healthcare professionals across the country. The list below is a simplified version of the 10 most popular tasks that are performed in the healthcare revenue cycle. Most other tasks related to this procedure, such as reconciliation of payments, patient statements, financial reporting, etc. are derivatives. Only an efficient execution of these crucial tasks, with the correct accuracy when entering the data and a diligent follow-up with payers will guarantee the highest financial performance for any healthcare practice.
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