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The Primary Elements of Revenue Cycle Management

The demand for the effective management of Accounts Receivables for medical practices has created a huge market for solutions referred to as Revenue Cycle Management (RCM). RCM correctly handles the complex regulations that medical providers face to get paid for routine or critical healthcare providers. To make sure there is cash flow in a sector where reimbursement is highly regulated, dentists and physicians must hire people with particular RCM skills. Efficient management of medical receivables is made possible through contracting competent companies. The large insurance providers and Medicare cater for the majority of the healthcare in the States. The percent not paid for by the insurance companies is covered by patients. With the increased growth in high deductible health plan use, the balances paid for by the patients are going higher. Both these components of account receivables have to be managed through a time-sensitive and comprehensive process.

Medical receivables management does not start after a patient completes their visit or when the patient signs in for an appointment. Efficient RCM starts when the patient makes an appointment and ends when the patient pays for any amount not paid for by the insurance companies.

You will find the main parts of RCM, and each is critical to the cash flow of your medical practice.
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If the patient wants to schedule to make an appointment; the front desk should confirm the insurance coverage when the patient remains on the phone. They should request for co-pay amounts from the patients at the checkup before the patient ever sees the doctor. The insurance claim that has the right diagnoses and treatment processes is then submitted to the correct payer electronically through some known standards of submission. If there are any errors in the preparation of the claim or submission process, flagged claims should be submitted again when corrections are made.
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When claims are paid, the main payer which is the insurance company will send a remittance advice enabling the billers to post payments online and transfer any balances that are owed to a patient or secondary insurance claim for prompt payment automatically.

The trick to efficient management of account receivables is to follow them up. The providers should inform the billing office of any partial payments, denied claims and even claims that do not have errors but are still unpaid after a specific time. By prioritizing these unpaid claims by the amount, payer and reason, the agents of the accounts receivable may examine and get in touch with the patients and payers accordingly to ask for payment or status.

After tracking the insurance premiums and they’re applied Into the claim balance, the balances that remain are charged to the patient by printing the statements as soon as possible.