Medical Billing Forum
General Category => New! => : Prabhu June 30, 2016, 10:57:54 AM
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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.
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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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::) ::) ::) ::)
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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)
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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
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RichardP, Now I know what "Hero Member" refers to! Very kind of you to post A/R. ;)
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Revenue Cycle Management includes the clinical & administrative functions which aid in capturing, managing, and collecting revenue from the delivery of patient service.
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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 don’t 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 doesn’t have a referral, the claim will be denied and you won’t 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 house’s 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 center’s existing software eliminates time spent on manual data entry and ensures accuracy which minimizes costly billing delays.
Go electronic: With the exception of some worker’s comp submissions, electronic billing, electronic remittance, and electronic remittance advice (EOBs) are the standard today. The move to electronic billing will accelerate a center’s 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 physician’s 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.
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Here we go.. more from offshore :o
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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 physician’s 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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ICD10 was implemented a year and a half ago. ???
Meitsnay thinka datitsa offshorkay :o ;)