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Posted on 08/07/2017 in Arts & Entertainment by

The Primary Elements of Revenue Cycle Management

The demand for the efficient management of accounts receivables for medical practices has generated a huge market for services referred to as Revenue Cycle Management (RCM). RCM rightly addresses the complicated regulations that medical providers face to get paid for critical or routine health care services. To ensure that there is cash flow in a sector where reimbursement is highly controlled, dentists and physicians should hire individuals with particular RCM skills. Efficient management of medical receivables is made possible through contracting qualified businesses. The large insurance carriers and Medicare cater for the bulk of the healthcare in the States. The percentage not covered by the insurance companies is covered by patients. With the higher growth in high deductible health plan use, the balances that patients pay are going higher. Both these elements of account receivables have to be handled through a time-sensitive and extensive procedure.

Medical receivables management does not begin after a patient completes their visit or when the patient signs for a consultation. Efficient RCM starts when the patient makes an appointment and ends when the patient pays for any amount not paid for by the insurance companies.

There are the main parts of RCM, and each is vital to the cash flow of your medical practice.
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When the patient calls to schedule to make an appointment, the front desk should verify the insurance coverage when the patient is still on the phone. They should ask for co-pay amounts from the patients at the check-in before the patient ever sees the doctor. The insurance policy claim that has the proper diagnoses and treatment processes is then submitted to the correct payer electronically through some known criteria of submission. If there are any mistakes in the preparation of the claim or submission process, claims that are flagged should be submitted again as soon as corrections are made.
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When claims are paid, the main payer which is the insurance company will send a remittance advice enabling the billers to post payments online and transfer any balances that are owed to a patient or secondary insurance claim for prompt payment automatically.

The trick to efficient management of account receivables is to follow them up. The providers have to inform the billing office of any partial payments, denied claims as well as claims that don’t have errors but are still outstanding after a specific time. By giving priority to those unpaid claims by the payer, amount, and motive, the representatives of the accounts receivable may review and get in contact with the patients and payers according to the to the status or request for payment.

After tracking the insurance premiums and they’re applied Into the claim balance, the balances that remain are charged to the patient by printing the statements as soon as possible.