The Need for Automation:
The cycle is initiated when medical services are imparted to a patient and is only complete when all relevant claims and subsequent payments have been made. This process brings increasing complexities and the need for systematic revenue cycle management is crucial. The following factors need to be addressed:
Scheduling Appointments – The process of creating a systematic, yet patient-centric process of scheduling appointments that offers the patient the time priority that they require.
Insurance Eligibility Verification – The insurance details and eligibility criteria are acquired from the patient and then verified through relative protocol.
Patient Account Establishment – A process that initiates the patient's account within the organization and is consistently updated based on the services offered.
Medical History Identification – A thorough study and record maintenance that dwells into the medical history of the patient and all relevant factors that may or may not affect the patient’s health.
Insurance Coverages – Identifying the patient's insurance mandates and coverage and their relevant impact on the due processes for claims reimbursement, denial management, etc.
Patient Claims History – An analysis of the patient's history, which identifies if any claims have been rejected in the past, along with a record of the relative denial management.
Medical Billing – The process of creating accurate medical bills for the services rendered.
Coding and Claims – Medical coding summarizes the clinical encounter for claims to be prepared and sent to payers. Automating the coding process accelerates and prevents errors that might result in claim denials. This is one of the most talked-about implementations of healthcare automation.
