Revenue Cycle Management
Optimize Your Earnings
Nine Steps of Healthcare Revenue Cycle Management (RCM)
- Patient Registration or Patient Pre-Authorization: The patient registration step is the decision by the health insurance company as to whether a service, medication, procedure or equipment is medically necessary. This step may be bypassed in the case of a medical emergency. This step also gives the patient an idea of what they can plan to pay, which generally means you will receive your revenue quicker.
- Patient Exam: As you would guess, this is the time when the healthcare provider actually sees the patient to determine a diagnosis and plan of action moving forward.
- Coding: Coding is more of an internal process that does not impact the patient. Here, we translate the written descriptions of the patient condition and services provided into numeric or alphanumeric codes. Then we use these codes to generate health insurance claims and patient bills.
- Charge Entry: This step is where the charges for services provided are captured on the bill and then submitted to the insurance provider. This step requires full accuracy so that your services are properly billed and you are fully reimbursed by the payers, which is often referred to as revenue integrity.
- Claim Submission: This is a crucial step in the RCM process. You must submit claims properly so they will be processed and paid in a timely manner. At Excellent MBS, we use customized software that detects the inevitable human errors and submits most claims digitally. This software allows us to resolve issues quickly and secure your payments promptly.
- Payment Processing: After the claim is submitted and the insurance provider has remitted payment, we review the payments to ensure the billed amount has been received and applied properly. If there are errors in the claim that slow payment, our software also manages the clearinghouse process to update and resubmit.
- Patient Billing: After we submit the claim to the insurance provider, we send the required patient portion of the bill to the patient. Our software makes this part of the billing as simple as possible – it generates the billing statements, allows the patient to ‘click here’ from within the emailed statement to make immediate payment, and sends reminders if the patient lags behind in payment.
- Collection: If the patient does pay slowly, we also handle the collections process. As such, we monitor the accounts with outstanding balances and continue to pursue payments from those patients.
- Revenue: You get paid and keep your cash flow and your business healthy.
The growing complexity of payer requirements has made it extremely challenging for healthcare organizations to keep their earned revenue. To protect your organization from lost revenue and high overhead expenses, we offer proactive revenue cycle management, real-time reimbursement analysis and resolution of causes for denied claims.
Excellent MBS will dive into your books and formulate a holistic overview of your practice processes and cash flow. Once we understand your current processes and procedures, using our deep knowledge and experience of systems that have helped create successful businesses, we will put together new ideas and direction for improvement for your business. Our primary goal is to help you minimize your expenses and maximize your profits.
As further data for the practice overview, we provide you with regular reporting to help you see the big picture. We help you spot trends and determine best steps to make improvements for efficiency and cash flow. Some of the advanced reports that help with this analysis may include:
- Charge & Revenue Analysis
- Coding Analysis
- Procedure Analysis
- Payer Reimbursement Analysis
- Provider & Staff Productivity Analysis
- AR Aging Analysis
- ICD-10 Transition
- Chart Accuracy Review