Poll

What is revenue cycle management and can any one provide me step by step procedure in billing cycle?

Revenue
1 (100%)
Cycle
0 (0%)

Total Members Voted: 1

Voting closed: July 30, 2016, 07:57:54 AM

Author Topic: Revenue Cycle Management  (Read 1775 times)

Prabhu

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Revenue Cycle Management
« on: June 30, 2016, 07:57:54 AM »
What is revenue cycle management and can any one explain in detail about the billing cycle with step by step procedure.

Michele

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Re: Revenue Cycle Management
« Reply #1 on: June 30, 2016, 01:25:53 PM »
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? 
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PMRNC

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Re: Revenue Cycle Management
« Reply #2 on: July 01, 2016, 10:53:46 AM »
 ::) ::) ::) ::)

Linda Walker
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www.billerswebsite.com

RichardP

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Re: Revenue Cycle Management
« Reply #3 on: July 02, 2016, 09:31:54 PM »
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

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Re: Revenue Cycle Management
« Reply #4 on: August 29, 2017, 02:10:49 PM »
RichardP, Now I know what "Hero Member" refers to! Very kind of you to post A/R.  ;)

danibrittany64

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Re: Revenue Cycle Management
« Reply #5 on: February 13, 2018, 01:34:53 AM »
Revenue Cycle Management includes the clinical & administrative functions which aid in capturing, managing, and collecting revenue from the delivery of patient service.
I am 27 and I like to read and write on a multitude of topics which often is a way to keep my grey cells in motion. This lets me stay on greener pastures where positivity is indeed a virtue. Giving my opinions in response to threads create interesting scenarios for the people, in general, is my pass

BikhamHCare

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Re: Revenue Cycle Management
« Reply #6 on: April 05, 2018, 12:33:09 PM »
Here are some important steps in revenue cycle management.

Schedule with accuracy: We want to know the right information time a  patient is scheduled seems pretty standard, it is a task many centers struggle with. If you donít get it right the first time (patient name, insurance numbers, birthdate, etc.) a lot of time will be wasted later chasing it down, which can potentially result in denied claims and delayed collections. Unfortunately, the demographic and insurance information supplied by physician offices is sometimes incorrect.

Online pre-admission technology can assist with ensuring accuracy. Enabling patients to complete their medical histories (including demographic and insurance information) at a time and place that is convenient for them typically yields more accurate information. Systems like One Medical Passport offer facility-wide secure access to pre-admission information which is very helpful for nursing staff and the billing department.

Perform benefits verification in advance: Making sure a patient has coverage well in advance of a procedure will allow you to identify any potential issues up front. If an HMO patient doesnít have a referral, the claim will be denied and you wonít be paid. There are several online sites that can assist with insurance verification. For example, the cloud-based EASE eligibility application tracks insurance data, surgery coverage qualifications, and benefit details.

coding and billing success: While coding and billing is something that can be successfully outsourced, particularly for those centers without the software, staff or space to do it themselves; for those that opt to keep it in-house, a clearinghouse is a must. Partnering with a clearinghouse typically results in claims being processed more quickly and with greater accuracy. A clearing houseís responsibility is to ensure everything is properly formatted and that files are transmitted to the insurance carrier in a timely manner. Look for a partner that can integrate with your existing revenue cycle management software such as ZirMed and SourceMedical. The ability to pull information already entered into a centerís existing software eliminates time spent on manual data entry and ensures accuracy which minimizes costly billing delays.


Go electronic: With the exception of some workerís comp submissions, electronic billing, electronic remittance, and electronic remittance advice (EOBs) are the standard today. The move to electronic billing will accelerate a centerís cash flow as well taking advantage of electronic remittance. With electronic remittance, insurance companies directly deposit payments using electronic funds transfer rather than mailing a paper check. Anything that eliminates paper, postage and manual processes is best.

Plan ahead for ICD-10: Because coding will be more complex when ICD-10 takes effect, you want staff that is not the only current on coding, but understands the increased level of detail required by physicians; physician education is equally as important to ensure all necessary details are provided within the physicianís operative reports. Inquire with your software vendor to make sure they are ready for the conversion. Because hiccups are likely to occur, consider opening a bank line of credit.

PMRNC

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Re: Revenue Cycle Management
« Reply #7 on: April 05, 2018, 02:19:06 PM »
Here we go.. more from offshore  :o
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Michele

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Re: Revenue Cycle Management
« Reply #8 on: April 06, 2018, 07:24:16 AM »


Plan ahead for ICD-10: Because coding will be more complex when ICD-10 takes effect, you want staff that is not the only current on coding, but understands the increased level of detail required by physicians; physician education is equally as important to ensure all necessary details are provided within the physicianís operative reports. Inquire with your software vendor to make sure they are ready for the conversion. Because hiccups are likely to occur, consider opening a bank line of credit.


ICD10 was implemented a year and a half ago.   ???
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PMRNC

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Re: Revenue Cycle Management
« Reply #9 on: April 06, 2018, 11:39:38 AM »
Quote
ICD10 was implemented a year and a half ago.   ???

Meitsnay thinka datitsa offshorkay   :o ;)
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com