The high demand for effective and efficient account receivable management, specifically for medical practices is said to have created a huge market, especially in regards to services known as Revenue Cycle Management or RCM.
Revenue Cycle Management or RCM addresses appropriately the complex regulations that most medical providers tend to face while getting paid for the healthcare, critical or routine services provided by them. For ensuring better cash flow, in the industry, where reimbursement is said to be highly regulated, it has become vital for both dentists and physicians to employ people having particular RCM skills.
Major components of Revenue Cycle Management
There are vital RCM components and each of them is necessary for the medical practice cash flow.
1. Insurance verification:
At the time of booking an appointment for the patient, the front desk needs to verify the insurance coverage on the net, with the patient being on the other end of the phone. The details of the patients' co-pay amounts need to be requested during check-in, much before the patient gets to meet the provider in person.
2. Claim submission:
Insurer claims along with appropriate codes for treatment procedures and diagnoses are to be submitted to the correct payer electronically through established submission standards (EDI). In case, if errors are present in the submission or claim preparation process, then flagged claims are to be resubmitted, once they are rectified.
3. Payment processing:
At the time of paying the claims, the insurance company (Primary payer) would dispatch a remittance advice, which would allow billers to post the payments electronically and to transfer the balances to the patient responsibility or secondary insurance claim for presenting automatic and timely payments.
4. Follow up of accounts receivable:
It is considered to be the key towards effective receivables management. The billing office is to be alerted by the provider to partial payments, denied claims and also claims that were actually error free, however, are unpaid even after the specified time frame.
Therefore, by having prioritized the unpaid claims by reason, payer and dollar amount, the representatives of accounts receivable can have the patients' or payers' reviewed and contact them for requesting payment status.