An efficient and professional healthcare system is based on a few elements that include the various health providers, medical equipment, medical machines, and other components, medicine, and drugs that are used treatment of diseases, insurance companies, and medical billing staff. Clinical practice needs proper financial resources to ensure not only the delivery of proper care to the patient but payment to the health professionals and other support staff, and also payment of other expenses.

The significance of the Revenue Cycle in the Healthcare system 

“Revenue cycle management is essential to complete the tasks and allow the different practices to run smoothly. Professional management software is needed that have automated key function such as scheduling patient treatment, medical billing, and coding, claim generation, and submission to insurance companies, and collection of payment. Only a single mistake in entering the correct detail about the patient or assigning incorrect CPT codes can interrupt the revenue flow of a healthcare practice.

Medical facilities such as hospitals and health centers depended on proper reimbursement for the healthcare services provided by a healthcare professional to the patient. The medical practice can sustain and grow if the revenue cycle is effectively and efficiently managed. Medical billing outsourcing can help practices to maintain their revenue cycle.

Some important key steps for successful medical billing.

1. Patient registration: –

The first and foremost step is to note down the patient demographic, and patient details like patient name, patient date of birth, patient social security number, address, gender, phone no, and patient insurance information which includes.

  • Patient insurance id no.
  • Name of payer and insurance plan.

The demographic information of the patient and insurance details must be noted down carefully and updated if the patient visit regularly. Today, medical billing services for small practices can reduce the burden of practice and also help them to increase revenue. 

2. Insurance Verification: –

It is very important to verify the patient’s insurance information and eligibility during every clinical visit. The patient’s insurance plan and coverage status can change at any time. It is very important to verify the insurance verification because it may damage the whole revenue cycle. Any changes in the insurance coverage and plan impact the patient’s authorization and benefit information.

3. Encounter information: –

Patient encounter information should be recorded to ensure the right details and diagnosis were done and claims could be generated accurately.

4. Medical transcription: –

A qualified, experienced, and professional medical coder will listen and see the encounter recording to ensure the correct translation of patient information into a medical script which may be used in the future if the patient comes again for a visit. This step must be error-free because this information is used for the correct treatment and follow-ups.

5. Charge Entry: –

It is the very first step in preparing the claim form that is submitted to the payers, and without accurate information and amount, the payment cannot be reimbursed. 

The medical claim form mostly includes the information.

  • Patient medical history.
  • Patient demographic information.
  • Correct CPT and ICD codes.
  • National provider index (NPI) no and payer id.
  • Social security number (SSN).
  • Place of service code like in telehealth services a biller should use a 95 modifier for reimbursement of claims. 

All information should be checked thoroughly because it reduces the denial rate and increases revenue with timely payment.

6. Claim Submission: –

A medical biller added the patient information, healthcare professional information, and provided services information in the claim form and submit it to the payer for reimbursement. Today, medical billing outsourcing uses different software to submit claims electronically.

Three steps ensure correct claim submission.

  • Electronic health record (EHR) software checks the important field in the claim is filled or not. This software does not submit a claim without filling in the important field in the claim form.
  • All information is verified by the third party or by the payer like the patient’s date of birth, patient name, and insurance information. This process helps a lot to reduce the denial rate.

7. Account Receivable: –

In accounts receivable, a biller does follow’s-up to reduce the denial rate of claims. A biller verifies the payment of claims. If it is not paid then he fixed the errors and resubmit the claim without any errors.

8. Payment Collection: –

After verification of all things, the insurance company decides to pay the claim then an electronic fund transfer or a paper check is made. The summary of payments is called the explanation of benefits (EOB). A professional medical billing team is responsible for payment posting all entries in the EHR software to match the payment received.