General Category > New!
Revenue Cycle Management
Prabhu:
What is revenue cycle management and can any one explain in detail about the billing cycle with step by step procedure.
Michele:
https://www.ohsu.edu/xd/about/services/patient-business-services/revenue-cycle/ describes revenue cycle management very well. As for the second part of your question, are you asking for someone to describe the entire billing cycle in a post on a forum?
PMRNC:
::) ::) ::) ::)
RichardP:
Just because I have it handy. Someone else may find it useful. A checklist for when we have newbies. A/R = Accounts Receivable.
Services and processes involved in Medical Billing
How will you ensure that these happen WHEN they are supposed to and
HOW they are supposed to?
1. Patient Demographics & Insurance Entry
2. Insurance Verification
3. Change of Address
4. Change of Insurance
5. Verify that Points 1-4 are correct in the database
6. Coding from Patient Chart (CPT, ICD-10, and HCPCS)
7. Coding Clarification with Doctor
8. Data Entry of Procedure (CPT) and Diagnosis (DX) Codes
9. Use of Modifiers and Order of Connecting Dx
10. Connect Diagnosis to Procedures
11. Review Forms for Correctness
12. Submit Insurance Billing to Clearinghouse
13. Scrubber / Failed Claims Corrections, Re-billing
14. Insurance Denials / Rejections analysis, Corrections, and Re-billing
15. Insurance A / R Follow-up, Re-billing
16. EOB Payment Posting
17. Transfer responsibility from Primary Insurance to Secondary or Patient
18. Bill Secondaries
19. Insurance Payment Reconciliation
20. Send Patient Statements
21. Patient A / R Follow-up, multiple billings, and calls
22. Patient Payment Posting
23. Patient Payment Reconciliation
24. Patient questions about Insurance EOB or Patient Statement
25. Refunds to Insurance and Patient
26. Collection Agency Activity
27. Balance daily Charges and Payments (#19 & 23, again, for thoroughness)
------------------
From someone's website:
Software File Maintenance, Setup and Configuration
Charge Capture Procedures
Review of CPT and Diagnosis Coding for Obsolete and New Codes
Fee Schedule Analysis
Insurance Preparation Process
Use of Claim Pre-bill Edits and Correction Procedures
Claim Transmission Process to Clearinghouse
Claim Tracking and Receipt by Payer
Payment and Adjustment Process including ERA and Manual Posting
Denial Correction and Claim Resubmission Process
Claim Follow-up Procedures
Patient Billing and Collection Policies
Analysis of Accounts Receivables
Patient Scheduling and Registration Process
Patient Insurance Verification and Eligibility Procedures
Provider Credentialing
Additional Services Available
Shawn:
RichardP, Now I know what "Hero Member" refers to! Very kind of you to post A/R. ;)
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