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The Primary Elements of Revenue Cycle Management

The demand for the Successful Management of Accounts Receivables for medical practices has generated a huge market for solutions known as Revenue Cycle Management (RCM). RCM rightly handles the complex regulations which medical providers face to get compensated for routine or critical healthcare services. To ensure that there is cash flow in a sector where reimbursement is highly controlled, dentists and physicians should hire individuals with particular RCM skills. Efficient management of medical receivables is made possible through contracting qualified businesses. The large insurance carriers and Medicare cater for 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 paid for by the patients are going higher. Both these components of account receivables have to be managed through a time-sensitive and comprehensive process.

Medical receivables management doesn’t start after a patient finishes their visit or whenever 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.

There are the main components of RCM, and each is crucial to the cash flow of your medical clinic.

If the patient wants to schedule to make an appointment; the front desk should confirm the insurance coverage 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.

When claims are paid, the main payer that Is that the insurance company will send a remittance information allowing the billers to place payments on the internet and transfer any balances that are owed to an individual or secondary insurance claim for prompt payment automatically.

The trick to efficient management of account receivables is to follow them up. The providers should inform the billing office of any partial payments, denied claims and even claims that do not have errors but are still unpaid 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.
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