In this day and age, medical and healthcare IT services have started using revenue cycle management concepts like never before. It is a must to have a billing department which is efficient, or else one would lose out a lot of money in payer reimbursements, or even patient payments and more. Therefore, for healthcare IT service to run efficiently, one must understand and execute the concept well. Here below are important steps in revenue cycle management.
This would be the first step in the working of a revenue cycle, which benefits the provider and the patient. For the patient, they save time on filling long forms and waiting for doctors, and they get to know what the costs out of their pockets would be as well- no nasty charges to deal with later on. For the provide, when they show the patients the actual costs, chances are the bill would be paid on time and this would bring down incidences of bad debt for them (providers) too. At pre-registration, information such as the name of the patient, where they come from, their medical history, payment and insurance information etc would be taken and streamlined for patient satisfaction.
Registration of the patient is valid information being taken while pre-registration was on. The hospital would now check for errors (if any) that may have occurred and inform the patient as well, so that it doesn’t snowball into a humungous issue later on.
- Capturing charges
In this step, charges would be captured for the services and the same would be sent to the insurance company. This is a crucial step throughout the cycle of revenue management. Here the payers reimburse the hospital in full.
- Review of utilization
The main reason why a review is done is because one needs to confirm the plan provided for the medical service in question.
Coding maybe not be necessary for patients to know, but for the healthcare service provider it is important. It transfers all data gathered (written description) into codes (numeric and alphanumeric), which makes a map for the hospital to follow. This is then used by the billers to create bills and claims for the patients being treated.
- Submission of claims
Once the coding is done, the next step would be to submit those claims made to the insurance provider and get the payments processed as per the contract terms.
This process involves the applying or the rejecting of payments, once they are received. The payments would be analysed by the hospital staff (payments received from the insurance company) to check if any errors have been made which caused the payment to be delayed. There are many reasons why payments are rejected (patient details were not taken incorrectly at registration, and the data is not up-to-date or correct).
- Follow up
Here the hospitals would have to collect payments from third-party insurers, as per the terms and conditions agreed upon with the payer contract negotiations.
Here the accounts would be monitored for outstanding payments or payments that are being pursued- balances remaining from patients. Very critical as a step for revenue cycle management, which is why companies like Healimpilo should be taken into trust with their software.
You only want the best for your medical practice and for the patient at large, don’t you? Choose and trust Healimpilo to render all the above-mentioned steps and more.