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RCM stands for revenue cycle management. It is the financial process that healthcare facilities perform using a medical billing program (software). It helps healthcare facilities track the complete interaction of patients. It covers various things starting from scheduling appointments to adding the final payment of patients. In this blog, you will learn the basics of RCM in medical billing.

RCM is the combination of the business and clinical sides of healthcare. The process pairs the administrative information (patient’s name, insurance provider, other personal details, etc.) with patients’ healthcare data and patients’ treatment procedures.

Basics of RCM in Medical Billing

Here are the RCM basics when we talk about medical billing:

  • Registration Process of the Patient: Data includes verification of insurance to process claims for the services rendered.
  • Insurance Verification: The team of medical billing experts verifies the patient’s information. They conform to the responsibilities and eligibility of the patient, such as accumulated expenses, co-pay, deductible, etc. The staff uses software for data verification.
  • The Encounter: Once patients consult with a healthcare provider, their every single detail is recorded through audio or video. They submit this record to an RCM company that helps them in claiming the revenue.
  • Medical Transcription: After the patient encounter, the healthcare facility needs to convert the recording into medical scripts. It contains the health record of the patient.
  • Medical Coding: Then, they convert the transcribed information into healthcare codes. This process is known as medical coding.
  • Charge Entry: Before claiming service charges from the insurance provider, the service charges are entered into a sheet.
  • Charge Transmission: It is when they transmit claims with accurate codes using EDI (electronic-data-interchange) to insurance providers.
  • AR Calling: The focus of the AR (accounts receivable) caller is on increasing the flow of payment while lowering claim denials in the revenue cycle management.
  • Denial Management: Denial management is a significant factor in the RCM. It helps healthcare providers ensure great revenue generation and reduction in claim denials.

So, these are the basics of RCM in medical billing that are important to learn before anyone hires a medical billing company.

You May Also Read: Basics of Medical Billing and Medical Coding

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