Revenue Cycle 101: The Life Cycle of a Medical Bill

When you’re using automated billing software, it’s easy to send each claim instantly. Electronically billed claims will be paid first, so if you’re still on the fence about using software, that’s something to consider. This step consists of a deeper look into the patient’s insurance coverage. The staff carefully looks over insurance information, seeing whether the patient’s requested services are covered through their provider.

The last step occurs when a patient pays the blanace they owe the provider for their care. Depending on the amount, the patient may be able pay it off all at once, or they might need to work with the provider on a payment plan. With the reference to the payment posted to the practice accounts including patient and insurance revenue will be calculated. Each denied claim is analyzed and researched by denial management team for best course of action.

Charge Transmission:

For those who are unfamiliar with healthcare RCM, let’s first review what it is. Healthcare RCM refers to the strategic approach healthcare organizations adopt to oversee the financial aspects of patient care. It involves the management of clinical and administrative functions that contribute to the capture, management, and collection of patient service revenue. RCM encompasses the entire process of managing healthcare provider revenue, from patient registration to payment posting. Revenue cycle management is an important part of the financial operations of healthcare.

Accurate recording of services provided, medications administered, and procedures performed is essential for proper billing. Implementing advanced charge capture technologies can streamline medical billing cycle steps this process, minimizing the risk of missed charges and maximizing revenue potential. The superbill contains all of the necessary information about medical service provided.

Potential Billing Problems and Returned Claims

The first step in claim denial management is identifying where the problem is and then managing it accordingly. Efficient payment posting is the final piece of the revenue cycle puzzle. Timely recording and reconciliation of payments received from insurers and patients complete the financial loop. Advanced payment posting systems help identify discrepancies, allowing for swift resolution and preventing potential revenue leakage.

Once you’ve sorted out your important KPIs, you can create reports to track and optimize the workings of your practice—including your medical billing workflow. If you want your practice to function as smoothly as possible, it’s important to determine what Key Performance Indicators (KPIs) matter to you. You may want to track the total number of new patient starts, revenue by provider, or revenue per procedure, for example. Take the medical codes and make a superbill, which is a detailed invoice outlining the services provided to the patient. It’s essential to know how to read the remittance advice (RA)/explanation of benefits (EOB) and know where things go in your system. “Don’t just resubmit the claim without finding out why it was rejected or denied in the first place,” Daily said.

Medical Coding:

Certified professional billers are needed at all stages of the billing process but claim preparation and post-adjudication activities demonstrate the education and expertise required of this profession. At this point a provider will determine whether the appointment and procedure will need prior authorization from an insurance company (referred to as the payer). Provider credentialing is the process where the provider connects with the payer for approval following a set of standard steps.