In the medical industry, clinical personnel, nurses, and doctors play the main role in saving lives by treating patients. However, the revenue cycle is something that healthcare facilities and hospitals depend a lot on. If the revenue cycle is not smooth, they cannot operate in the long run. So, coding and revenue cycle management become so important.
Main Elements of Coding and Revenue Cycle Management Field
Coding and RCM is a process that helps manage the financial and administrative functions linked with patient benefit verification, registration, claim processing, payment & collection, coding, etc. Here are the main elements of this field:
Patient Pre-Authorization
The patient needs to undergo a pre-authorization process before a doctor sees him. During this process, the insurance provider decides whether he is eligible for a service, procedure, or medication.
Insurance Eligibility & Verification
Healthcare office software may check the eligibility of patients through the internet on secure channels. Patient verification about a certain benefit could be speeded up by utilizing dedicated RCM software.
Charge & Code
Coding plays a key role in physician reimbursement, quality review, hospital payments, benchmarking measurement, collecting general healthcare statistical data, etc. Accurate coding is essential for successful revenue generation.
Claim Filing & Submission
It is the most important phase in the process. Reimbursement depends directly on accurate claim filling & submission. RCM and coding personnel assist ensure that you get reimbursement on time.
Denial Management
When an insurance provider rejects a claim, an RCM professional helps remove the errors causing claim rejection. He scrubs claims for possible coding errors before submitting them on time.
Collections
Reduced reimbursements show that the healthcare plan didn’t cover all services. Therefore, an RCM professional should step in and get in touch with the relevant insurance provider right away. He must make the required adjustments and check documents for possible errors.
The role of the RCM manager and staff is undeniable. Through coding and revenue cycle management process, you can make sure that clinics and hospitals receive proper and timely payments for services they offer.
You May Also Read More: Preparing a Clean Claim in Medical Billing