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The Main Components 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 correctly handles the complex regulations that medical providers face to get paid for routine or critical healthcare providers. To make sure there is cash flow in a sector where reimbursement is highly regulated, dentists and physicians must hire people with particular RCM skills. Efficient management of medical receivables is made possible through contracting competent companies. The big insurance providers and Medicare cater to the bulk of the healthcare in the States. The percentage not covered by the insurance companies is covered by patients. With the increased growth in high deductible health Plan use, the balances which patients pay are going higher. Both of these elements of accounts receivables have to be managed through a time-sensitive and comprehensive process.

Medical receivables management does not start after a patient completes their visit or when the patient signs in for an appointment. 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.

You will find the main parts of RCM, and each is critical to the cash flow of your medical practice.
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When the patient calls to make an appointment, the front desk should verify the insurance policy when the patient remains 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 claim that has the right diagnoses and treatment processes is then submitted to the correct payer electronically through some known standards of submission. If there are any errors in the preparation of the claim or submission process, flagged claims should be submitted again when 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 key to efficient management of accounts receivables is to follow up on them. 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 prioritizing these unpaid claims by the amount, payer and reason, the agents of the accounts receivable may examine and get in touch with the patients and payers accordingly to ask for payment or status.

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.