RCM or revenue Cycle Management is the process that aids in the financial processes to manage the clinical and the administrative functions associated with the end to end management of claims processing, payment, and the revenue generation. The process involves the process of identifying, managing, and collecting the service revenue of the patient. This is important to ensure organizations are in operation and facilities, collect profits and keep up with the expenses.
Accounts receivable (AR) and denial management is a crucial part of the medical billing revenue cycle management. It helps in identifying the adjudication status of a submitted claim and understands its outcome. If detected early, it can be prevented for untimely appeals or corrections
Healthcare employees deal with a lot of industry terminology like co-pay, deductible and claims. Having appropriate knowledge of these terms help in easy understanding of claims process and allows error free transaction.
The process of verifying a patients health insurance coverage and benefits with an accepted payer is called eligibility check and verification. This helps determine what services are covered and the amount of coverage that is available.
It is a crucial step of RCM. It involves getting a picture of posting and deposit functions and reconciling the posting activities and deposits. It also gives an entire picture of the economic cycle, the leaks, and has a major impact on the patient satisfaction, efficiency and the financial performance.
A claim form is a document that tells the insurance company details about the the illness or the accident occurred. It helps determine if the expenses covered under the insurance plan or not. The amount of information on the insurance claims form present the better and easier it becomes to process the claim.
A clearing house is an intermediation between a healthcare provider and an insurance payer. It checks medical claims for any errors and then sends them to the health plan for payment. They are generally electronic stations or hubs that allow transmit claims to insurance carriers.
The process by which the insurance company views the healthcare claims and decide if it is to be paid in full of in a partial amount and if it should be denied. It helps in verifying the authenticity of the claim, reviewing and analyzing the data, and checking if benefits are allowed for any of the services.