be_ixf;ym_202405 d_30; ct_100

Jerris Heaton

Revenue Cycle Management Process in Medical Billing

April 2, 2019

Biller, RCM 4 Minute Read

A medical practices’ mission is to provide optimal patient care to ensure positive outcomes. However, bogged down in the minutia of patient insurance verification, co-pays, deductibles, code approvals, claim processing and more, it’s challenging to keep focused on what matters most: the patient. Further, as you muddle through the maze of revenue cycle management, one error or lapse in the various processes can severely hinder practice efficiencies, delaying appointments, payments and reimbursements.

Embed this image on your site!

The Process of Revenue Cycle Management (RCM)

RCM services take the billing burden off the medical office, liberating providers and staff to concentrate on patient care. Your staff never needs to touch the billing system again, but how exactly does it work?

  1. It Starts with An Appointment
    • After a patient requests an appointment, an employee of the Doctor’s office will call to confirm the appointment details, demographics, and insurance verification.
  2. The Patient Arrives
    • Once the patient shows up for their appointment, they will pay any co-pays and/or deductibles that may be required before their visit. Once these are paid, the RCM team will post any payments made to the patient’s account to help keep payments organized.
  3. The Doctor Fills Out/Submits the Superbill
    • After assessing the patient, the Doctor will fill out the superbill with diagnosis codes that match his notes. Once he saves the superbill, it will automatically be submitted to the RCM team that’s in charge of his practice.
  4. The RCM Specialist Receives the Superbill
    • Each practice is assigned an RCM Specialist who oversees reviewing the submitted superbill. The review includes making sure correct codes & modifiers were used. If changes were needed due to improper codes, they will inform the doctor he needs to make an addendum to his notes to reflect the proper billing codes.
  5. Triple Scrubbing of Superbill
    • After the RCM Specialist has reviewed the superbill, the billing software will automatically scrub the superbill, then they will then send it to the clearinghouse for a final review. The clearinghouse will either approve the submitted superbill or let the RCM Specialist know what codes need to be fixed.
  6. Submission to Insurance Companies
    • After the superbill has been deemed correct, it is then submitted to the proper insurance companies by the RCM Specialist. A good RCM company should have a 98% or greater first pass claims acceptance.
  7. If Denied for Any Reason
    • The RCM team will correct the errors on the superbill that caused the claim to be denied and then re-submit the claim back to the insurance company.
  8. Insurance Pays Out the Claim to the Practice
    • The practice receives money from the submitted claim and the RCM team reconciles the payment to the correct patients account showing that they have paid their bill.
  9. Full Custom Reporting
    • In addition to taking care of the full revenue cycle, the RCM team will build out custom reports detailing co-pays, claims, balances, outstanding A/R, and anything else the practice wishes to report on.

ChartLogic Revenue Cycle Management

Using proven and accurate billing practices, ChartLogic Revenue Cycle Management (RCM) services help practices navigate the precarious medical billing network. From patient eligibility and payments, coding to claim submission and denials, ChartLogic provides end-to-end collection services that increase financial performance without increasing costs, saving medical offices money while liberating providers and staff to concentrate on patient care.

With ChartLogic as your Revenue Cycle Management partner, your staff never needs to touch the billing system again. Above is a helpful infographic that guides you through ChartLogic’s RCM services step-by-step. If you would like to speak to an expert about RCM services you can request a demo or use our ChatBot tool in the bottom right-hand corner of your screen and someone will reach out as soon as possible.

Related Posts