This is very beneficial for hospitals and healthcare practitioners all around because it lets you focus more on your work than in filling out insurance claims and activities that keeps you from taking care of your patients.
How can RCM help the Healthcare industry?
Communicating with health insurance companies is a key component of RCM. When a patient schedules an appointment, the physician’s office or the hospital staff typically checks the patient’s reported insurance coverage before the visit.
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. 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.
What’s involved in RCM
Here is what’s involved in the revenue cycle:
- Charge capture: Rendering medical services into billable charges.
- Claim submission: Submitting claims of billable fees to insurance companies.
- Coding: Properly coding diagnoses and procedures.
- Patient collections: Determining patient balances and collecting payments.
- Preregistration: Collecting pre registration information, such as insurance coverage, before a patient arrives for inpatient or outpatient procedures.
- Registration: Collecting subsequent patient information during registration to establish a medical record number and meet various regulatory, financial and clinical requirements.
- Remittance processing: Applying or rejecting payments through remittance processing.
- Third-party follow up: Collecting payments from third-party insurers.
- Utilization review: Examining the necessity of medical services.