Health and Fitness

A step-by-step Guide to Outsourcing Your Revenue Cycle Management

An average American visits a healthcare provider at least four times a year on an average. Keeping this in mind the need for medical checkups is always on the rise. As each patient has their own set of health issues that require careful speculation by the doctors. This further leads to lengthy diagnostic lab testing, X-rays, ultrasounds, medications and ongoing treatments which might include major surgeries. As each visit costs a certain amount that is owed to the provider. The need for micromanaging the revenue cycle management for higher collection of reimbursements becomes a top priority for caregivers. This whole process of medical billing has several steps in order for insurance payers to release the owed monies to providers.

These systematic steps lead to best outsourcing practices for highest revenue cycle management

  1. Patient Registration:

The basic step of patient registration involves the initial collection of patient history along with all patient details. As soon as the patient walks in the front end staff sets up the doctor’s appointment. After the checkup the medical bill is sent over to the medical billing company to file a claim on the provider’s behalf. This is a fairly simple process initially, but it should be carefully evaluated. Patient check and check out are thus essential to turn it into a super bill. This is where the medical billing and coding assessment and compilation begin. Outsourcing helps with the correct details that need to be filled in initially.

2 Insurance Verification Protocols

As every patient has a unique case scenario they require different kinds of medical treatments as per their physical condition. Outsourcing can greatly help reduce issues regarding insurance verifications. People with debilitating diseases require immediate attention, so their medical bills can be recurrent. Whatever the case may be a lot has to be carefully evaluated which might include a brief summary of deductibles, co-pays or checking upon patient responsibilities. Some treatments need prior authorization in order for the treatment to begin. In this kind of special cases patient data is secured using patient portals.

  1. Patient Experience Records

The patient and caregivers interaction is kept as a written record to have proof of a quality medical treatment. This information can be later accessed to verify the actual condition of the patient in terms of diseases progression. Any added information relevant to the future visits can thus be forward to the medical billing department to file an accurate claim. The entire interaction of the patient with the caregiver is crucial for reference if there are any mismatches in the treatments given and the bills furnished in accordance to them.

  1. Patient Medical Transcripts

Converting the patient’s visual or audio records during a vital medical checkup into a medical billing format is done by transcriptionists. Medical transcriptions usually include patient history, exam notes, operative reports, referral letters, discharge summaries, and other medical documents. There are professional medical transcriptionists that are trained in recording the patient history in the form of written reports and audio tapes that can assist in processing a certain medical time. It’s best to outsource this type of work as it is highly time-consuming.

  1. Assigning Codes to Bills

After careful evaluation of treatments, medical conditions and number of patient check-ups codes are assigned to them. Specific medical codes have to be distinct to each medical treatment. Medical coding saves time and professional coders are experts at using ICT- 10 codes. Using the right codes can make a huge difference in the final bill. A professional medical billing and coding company makes this job much easier and automated. Outsourcing medical coding takes the load off the physician and their medical billing is quicker and the revenue generation is on the higher side.

  1. The Aspect of Charge Entry

Charge entry is crucial to the successful medical billing practices today. Before medical bills are sent to insurance payers there is a certain list of details to be looked at in order for accurate billing to occur. These might include dates of service, Admission dates, place of service, pre-authorizations, CPT codes, billing and rendering providers and also modifiers. Medical billing outsourcing helps in centralizing this for the providers to save time and money.

7. Medical Charge Transmission

Claims have to be filed with immaculate supervision through EDI ( Electronic Data Interchange) which is submitted to the insurance agencies. This process is known as charge transmission. In order to increase the submission of clean claims this process is highly focused upon. If the claims have any type of errors they are rejected and sent back to the billing company. As insurance agencies have their own set of rules and regulations that they look into before acceptance of acclaim it is important to seek out a medical billing company and outsource this side of medical billing for fast results.

  1. Accounts Receivables Management

Having a dedicated A/R team to follow up on claims is crucial to having a strong medical billing backbone. Account receivables are the cash owed to caregivers or medical billing companies for services rendered. Verifying and posting receipts is the most important part of account receivables. Having a profession medical billing company to do this job is fairly recommended as it helps in ample amount of medical bills being settled on time. It is the objective of every seasoned medical billing company to resolve any loopholes that delay the A/R process.

  1. Denial Management

There are various reasons acclaim may be denied by insurance firms that may include missing information, coding errors,  non-scrubbed claims, insufficient medical necessity, claim form errors or even lack of preauthorization’s. Outsourcing to a professional medical billing company can reduce the pitfalls associated with the denial of claims. Timelines are crucial in billing and coding practices as late submissions can increase in rejections from insurance payers. Most providers like to avoid this risk and hire a medical billing company instead. The benefits of a clearing house for this are essential for accurate claims scrubbing and a higher rate of cleaner claims.

  1. Payment Posting

This is the final step of the medical billing and coding process that leads to accurate revenue cycle management. A team of billing and coding professionals can help narrow down the timelines for posting payments. It includes the thorough checks on Explanation of Benefits documents for a transparent process. Another strong document is the Electronic Remittance document that is supposed to be delivered to the patient for the clarity on their billing details and how the insurance payers choose to process the claims that were submitted. Outsourcing this kind of work can help save thousands of dollars annually for providers.

Greensense Billing is highly experienced in revenue cycle management for the long-term success of any medical facility. We have established a strong network of providers who are extremely satisfied by the strength of our coding and billing experts in generating the highest revenue possible.

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