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Revenue Cycle Management

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What is revenue cycle management and can any one explain in detail about the billing cycle with step by step procedure.

Michele: 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? 

 ::) ::) ::) ::)

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

RichardP, Now I know what "Hero Member" refers to! Very kind of you to post A/R.  ;)


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