Introduction: Revenue Cycle Management is based on managing doctor’s revenue through various processes and methods. Here we are particularly saying about US doctor’s and their billing structure (how US billing system work). Major work stack is between Doctor’s and Insurances. Let’s see the major Key components in this cycle of medical billing and coding.
Major Key Components: Doctor, patient & insurance are the major key component in RCM. First doctor needs to be contracted with insurances, they note all details of doctor and share these details with patient who buy insurances. Patient don’t have to pay major part of bill to doctor’s that will be cover by insurances. Patients have only 3 responsibilities to pay (1. Co-pay, 2. Co-insurance co-pay & 3. Deductible) and this will be dependent on what insurance plan you are buying. After buying insurance plan patient got list of doctors near their area and insurance card on behalf of that medical bills get settled. Patient just have to book appointment and take treatment/consultation rest all the records and bills are maintained by doctor and his billing team. Now let’s see how this billing process works.
Medical billing Processes: There are major 4 team who work for doctor to maintain their revenue and rotate the cycle. Coding/Claim Processing/Payment Entry/Account Receivable (AR) apart from this there are Credential team also who take care of doctor contract with insurance and renewal process.
1. Medical Coding: This is very critical part of revenue cycle management, need CPC certified person. Here coder who have done CPC certification, need to convert all diseases and procedures into alpha numeric codes (99201–99215 CPT, U7 modifier, I10 ICD)on behalf of doctor medical records. Need to look on CPT,ICD & Modifiers what are they. CPT : Current procedure Terminology these are the converted code for the treatment performed by doctors, ICD: International Classification of Diseases these are the converted code for diseases that patient is having, Modifier: these code used to convert or modify the meaning of claim processed.
2. Claim Processing: In this process patient details will be entered in practice management software/web application like Kareo, Caretracker, Eclinical etc.. First step is to enter patient demographics (Like name, address, family details insurance plan/ID) and then all the related CPT, ICD & Modifiers according to insurance guidelines. After completing all necessary details claim need to post to insurance server. Then insurance company review the claims if the claim is approved then payment for doctor is released and if not approved then claim got rejected and went back to AR team. Now lets first see how payment is handled then rejected claim.
3. Payment Entry: After getting approved claim from insurance a check or electronic payment is released for doctor and this payment team need to enter all the payment detail in particular practice management software/web Application on specific claims. Basically, this process is call ERA & Non-ERA payment entry.
4. Account Receivable (AR): When a claim got rejection by insurance there are several reasons which detected by AR team and solve them by calling insurance companies & patient. After making claim correct again AR team submit the claim to get this paid. Basically AR team are checking each and every claim that was processed but not paid by any reason.
As you can see the criticality of the process this need skilled and certified person with all the tools and equipment that will create a big expense budget for doctor. Just to cut down the expense there are many medical billing companies who have offshore offices in different countries like India where they got all necessary thing in very low cost like skilled & certified person, building for staff, good internet and high quality equipment and many more. All the services are provided to doctor by billing companies on very low prices, just because of these billing services doctor can fully focused on patient and their treatment. One of the best billing company is CredablePro.
Frequently asked question
1. What charge does these medical billing companies charge from doctors?
It all depends on how doctor want to pay percentage wise, hourly based, seat based. Every segment have different percentage and rate.
2. Does CredablePro Follow HIPPA?
Yes, on strict way. This will be followed through Information Security Management System (ISMS).
3. Is outsourcing secure?
Yes, different billing companies are using HIPPA with ISMS certification that will be audited and checked by authorized companies. Through this certification security will be provided on outsource work.
4. How many companies are there in market?
Countless, but the best in quality and charges are CredablePro.
Conclusion
Revenue Cycle Management is not only about doctor, patient and insurance plans this is all about the process of generating revenue from doctor’s billing and the teams are working on this. How they face things, save doctor time and money. There are different billing companies who are giving different billing services to doctor’s from a long time. Hope this article gives you a brief knowledge about Revenue Cycle Management, in case of more knowledge visit www.credablepro.com.
