It creates a means of communication between providers and between providers and members about health status, preventive health services, treatment, planning, and delivery of care.
Medicare and Medicaid have started reducing physician reimbursement. Third-party payers Aetna, Cigna, etc. Because of such issues, medical practices are striving to improve their revenue cycle processes.
Foundations of the Revenue Cycle Without a good base on which to build revenue cycle processes, medical practices will not be able to achieve optimum functioning of revenue processes. The foundation includes common sense and basic tools for the medical practice.
Great guest relations practiced by the providers and staff will go along way in attracting and maintaining a loyal patient base. Ongoing physician and staff education regarding all processes in the revenue cycle and their interrelatedness will help reduce problems in the revenue cycle.
A good practice management system that suits the needs of the practice is critical. In addition, having at least two staff members thoroughly trained including ongoing training when the system is updated and knowledgeable about the functionality of the system is a must.
The staff members can serve as the liaison with system support and provide training to all staff members who need to enter or retrieve data, or generate reports from the system. It is important that the financial policy is in writing, has been reviewed by legal counsel, and the patient signs and receives a copy of the policy.
Finally, the importance of building files into the practice management system cannot be overlooked. Loading and maintaining accurate payer and patient information in the system will alleviate many revenue cycle problems.
Building in Medicare, Medicaid, and certain fee-for-service contract fee schedules into the accounts receivable module will help monitor accuracy of payments. Using must-fill fields helps avoid errors of missing required data.
Medical practices should use a check sheet or script guide to be sure all pertinent information is collected at the time of scheduling. At a minimum, the type of insurance the patient has will help the scheduler know what information to collect from the patient.
The patient should be informed if the providers are not in the insurance network. Additional items to discuss with the patient include explaining what information the patient should bring to the appointment, the expectation of payment of co-pays at the time of the visit, and the arrival time of the patient if certain paperwork and registration work needs to be completed.
Registering or updating the registration of the patient is the next revenue cycle process. At each visit the basic demographic information should be confirmed. New patients, and at least annually for established patients, a patient information form should be completed by the patient.
The patient information form should capture all demographic and insurance information. Once a patient has completed the patient information form, a staff member should immediately review the form for completeness and signatures.
If the medical practice sees Medicare patients, the Medicare Secondary Payer questionnaire should be completed or updated by the Medicare patients at the time of registration. Co-pays can be collected at the time of registration, before the patient goes back to see the provider.
This helps improve the patient flow.
Depending on the type of medical practice, it may be necessary to have a staff member designated to complete pre-certification and prior authorization work.
Usually this position is beneficial in surgery, orthopedic, and neurology practices. If the medical practice performs tests or procedures that must meet specific medical necessity or frequency limits, a written policy and procedure should be in place to provide advance beneficiary notices to Medicare patients.Blood Disorders 1.
Amy, a 4-year-old Caucasian female, has been complaining of being tired all the time.
She is pale and a picky eater. Her mother is a single mom with a small budget to feed a large family. Steps in the Medical Billing Process Cris Lambdin HCR 6/24/12 Natalie M. Cooper Steps in the Medical Billing Process The role of a medical billing specialist in any type of medical practice is of vital importance, the skill, knowledge (both billing and clinical), and ability at which that individual can perform their duties can make or break a medical facility.
The first step in the medical billing process is preregistering the patient. The two main tasks of this step in the process is to schedule and update appointments, and to collect all the patients basic information; including the reason they need to be seen.
The medical billing process is extremely important to the financial health of the practice. If claims don't get submitted promptly, the doctors and their staff - including the medical billing specialist - .
Medical Billing and Coding Diploma; Medical Office Assistant Diploma; Online College Application Process. the admissions advisor will provide students with the steps required to complete the online admissions process at Bryant & Stratton College.
The process itself is free, quick and easy and the admissions team is on hand every step. Steps in the Medical Billing Process Essay Everything that is done in this world has to have a process whether it is an act as simple as cooking a meal or something more complex like the 10 steps to medical billing - Steps in the Medical Billing Process Essay introduction.