Five Steps Involved in Revenue Cycle Management Process for Healthcare
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Five Steps Involved in Revenue Cycle Management Process for Healthcare

Healthcare Tech Outlook | Monday, October 25, 2021

Revenue management is crucial for healthcare organizations to balance their operating cost, and so they must follow all steps of revenue cycle management process.

FREMONT, CA: Providers of healthcare must strike a balance between offering high-quality care while remaining profitable. To fund operating costs, all providers, regardless of size, must receive payments from health insurance companies and patients as soon as possible. As a result, revenue cycle management must be effective because it is the life of a patient's account from the first consultation till payment is received by the provider.

In the healthcare sector, revenue cycle management involves five steps which are as follows:

Pre-authorization

The provider collects the patient's health insurance and billing information at this stage. Using automated verification methods to confirm eligibility during this phase speeds up the process. It informs the provider on how they will be paid for their services and reminds patients about their responsibility to pay on time.

Capturing of services and fees

Medical payments must be collected as soon as the provider provides medical care to a patient. The required codes will automatically enter the claim when a practitioner employs a well-designed medical billing application. This prevents coding errors and guarantees that the claim is coded correctly from the start.

Submit the claim to the payer

Verifying and managing claims can be made easier with the help of a solid practice management solution. Before submitting a claim, it is usually a good idea to review and double-check the details. This lowers the chances of denial and assures timely payment. Providers might outsource their RCM and billing to a service provider to lower the number of refused claims.

Receive payment

The payer will pay the patient's medical bill once the patient's insurance provider has reviewed the claim. The patient is then informed of the fees, which must be paid in cash by the provider. Patients will receive payment alerts through the patient portal if they have a sound practice management system.

Process review

Providers need tools to look over the whole RCM process and figure out what's causing denied claims, late payments, and other problems. Providers can detect vulnerabilities in their revenue cycle management by using quality assurance reporting tools integrated with their billing software.

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