Revenue cycle management is the process in which clinical operational systems interface with financial practice management systems and reduce accounts receivable. The primary goal of all healthcare organizations is to focus on improving patient care, while efficiently maintaining their accounts receivables.
To achieve these goals, we can help your organization by improving your revenue cycle management processes. By implementing best practices and customizing options that fit your specific needs, we can increase revenue, reduce denials and improve workflows.
Review the information listed below to determine what areas PMPHASE can help your organization.
RCM Flowchart
Available Services
Coding
Healthcare coding is the process to transfer written clinical diagnoses, procedures, and other medical services into numerical values. Understanding this process within the revenue cycle process is crucial to not only patient care but to the payment of services as well. Coding is completed for both facility and physician
Billing
Healthcare billing is the preparation of forms to submit for reimbursement of services. This process is vital in revenue cycle management to ensure that healthcare claims for both facility and physician groups are submitted error-free to insurance companies and third-party payers.
A/R follow up
Accounts Receivable (A/R) follow-up is the process in revenue cycle management that requires teams to determine the status of all submitted healthcare claims. When the status has been identified the appropriate action is then taken to ensure receipt of payment.
Denial Management
The Denial Management process in revenue cycle management is to investigate all unpaid, underpaid, and no-response claims. Tracking trends, errors, and payer issues for reporting and recommendation of corrective actions. Appeals and root causes are also components of the Denial Management process.
Collections
Patient and payer collections are not areas that organizations review or even assess to determine if there is revenue loss by not conducting this process. The collection is the last process to conduct revenue recovery. Patient collections allow the organization to track clients who fail to follow the required payment policy. Payers are also required per their contract to make payments timely per their contract requirements. Bypassing the collections process allows a loss of 10% of your revenue.
