1. Health

Revenue Cycle Management

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Why RCM?

Revenue cycle management is a vital service in medical billing. Medical Billing services are being utilized by various providers including Urgent Care, Family Medicine, Internal Medicine, Pediatric & Mental Health to speed up the collections & cut down their cost down by 50%.

Steps in Revenue Cycle Management

  1. Credentialing

Payer enrolment for allowing you to network with various organizations.

  1. Eligibility and Benefit Verification

Checking the effective date of the patient’s policy and identifying the covered and non-covered services.

  1. Transcription

Converting the recorded audio files to Text /Medical records.

  1. Coding

Converting the medical diagnosis and procedures in medical records to Alphanumeric codes.

  1. Demographic and Charge Entry

Entering the patient’s details and alphanumeric codes into the billing software.

  1. Claims submission – Paper or Electronic

Submitting the claims or bills to the insurance company.

  1. Payment Posting

Payments are entered into the respective patient’s ledger.

  1. Denial Management

Corrective actions will be taken on unpaid/denied claims.

  1. Account Receivable Follow up

Addressing the no response claims.

  1. Patient statement

All the patient responsibilities would be notified to the patient in the form of statement/Bill.

Revenue Cycle Management Services

Eligibility and Benefit verification

Eligibility verification involves checking the effective date of the patient’s policy and making sure whether the patient’s policy is active for the given date of service. This could be done via website and reaching out the insurance representatives via phone.

Benefit verification involves checking whether the service is going to be rendered are covered under the patient’s plan and to determine the patient responsibility.

Medical Coding

Professional Medical coders help you to ensure the ICD-10 / CPT codes are applied correctly during the medical billing process, which includes abstracting the information from medical record documentation, assigning the appropriate diagnoses and procedure codes, and creating a claim to be paid by insurance carriers.

Account Receivable Follow up

Medical billing professionals would find out the claims for which we did not get a response from insurance even after 30 days from the submission. Follow ups via phone call or website would be made. Highly precise process ensures a recovery of unpaid claims.

Demographic and Charge Entry

Incorrect Demographic information is one of the reasons for medical claims being rejected. The correct and quality entry of Demographic information and charges positively impacts the quick settlement of the claims. Error-free patient demographic entry and charge entry is the first step in the process of submitting a clean claim.







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