A hospital or clinic’s medical revenue services are the foundation of their operations. How would you handle revenue management without them? Charge capture, billing, and revenue cycle management are some of these services. Hospitals or other third-party providers may offer these particular services. These services are crucial because they support a hospital’s or medical facility’s ongoing operations. Hospitals, provider groups, and other practices can all benefit from Medical Revenue Services assistance with revenue management.
Revenue Cycle Leakage Points:
Providers are unable to determine who is paying their bills due to a breach in the revenue cycle. This poses a challenge because the patient may decide not to return to the provider. The revenue cycle has numerous leakage points; however, the following are the most typical ones:
- Errors in registration, coding, or billing
- Unreliable coverage
- Unpaid claims
- Appeal denials
Importance of medical Revenue services:
In the last few years, medical revenue services have grown in significance within the healthcare sector. Medical providers now confront more difficulties in managing their revenue cycle due to increased regulations, value-based treatment, and rising healthcare expenses.
Using the Services of Medical Revenue:
It would help if you took care when utilizing related healthcare revenue cycle management services. Although there are various methods to use these services, it can be advisable to work with a provider who has the necessary training and experience.
Medical Billing and coding:
Healthcare providers, insurance companies, and patients can all make payments more accessible by using medical billing and coding, two linked professions. Medical coders examine the patient’s diagnosis and codes to determine the appropriate billing descriptor. In contrast, medical billers operate in an office to handle patient payments and insurance claims within the healthcare providers.
Medical Billing Categories:
1) Professional Billing:
When a patient enters the facility and sees a doctor in that office, that is when the billing happens. This can also apply to medical professionals who work for themselves in a private practice apart from a hospital or clinic. Experts charge for their services, and the insurance provider pays them back. The fact that professional medical billing is an office-based instrument should be understood first. The two primary tasks that support the office-based revenue cycle are billing and coding, both of which are frequently completed by professional medical billers,
2) Institutional Billing:
Medical billers must manage the billing for clinics, hospitals, rehabilitation centers, nursing homes, etc., to specialize in “institutional” billing. This covers the utilization of lab and additional services, equipment, and inpatient and outpatient services. Medical billers in this domain also need to be well-versed in CPT, HCPCS, and ICD-9-CM codes in addition to medical coding. Additionally, they are in charge of charging insurance companies for the services that doctors who practice in these institutional settings offer.
Payment by Medical Revenue Service:
Prior to determining what steps are necessary to address the patient’s medical condition, a doctor must assess the patient. Following the doctor’s provision of the required services, institutional or professional billing begins the medical billing procedure. The patient’s insurance company will then decide whether to pay for the treatment after receiving an invoice from the hospital for the services provided. After approval, they pay the hospital.
Metrics for Common Revenue Cycle Best Practices:
The following are some of the best practices:
Perform Frequent Financial Clearance:
Prior to the patient’s arrival for their visit, patient information needs to be updated and validated. Examine if you qualify for insurance, and keep track of any authorizations.
Simplified Check-In and Check-Out Procedures:
All previous and current balances are gathered, eligibility is assessed, and patient information is validated and checked.
Make use of an electronic method for this. In these situations, particular coding is used, and routine audits of the documentation are carried out.
To do this, fee schedules are created, maintained, and added to the system.
Electronic claims are filled out with frequent status updates; a secondary claim procedure is carried out, and care is taken to ensure compliance with the requirements set by the insurance carrier regarding claim format.
Final notices are sent out, and notes and automated holds are issued on patient statements where appropriate.
Payment and Denial Posting:
During this stage, payments are entered, and contractual write-offs are managed. This is to guarantee that patient claims are not denied as a result of administrative mistakes.
Ensuring that insurance companies receive and process claims, prioritizing accounts receivable, auditing staff collection efforts, and knowing your practice’s average days in accounts receivable and net collection rates.
Managing the process of appealing rejected insurance claims in order to maximize reimbursement is part of this service.
In this stage, patient billing takes place, along with the sending of collection letters and general collections.
Fee schedules are taken into consideration during this phase. Once medical practitioners have checked the bill for correctness, they enter the costs into the new system.
To sum up, The Medicator’s RCM system is an excellent instrument for monitoring receipts and payments related to medical revenue management. Many modules, such as those for patient scheduling, cash flow reports, cost reporting, and more, can help you get off to a good start for your practice.