PCUBE provides all the Revenue Cycle Management services for the healthcare providers. Our comprehensive services ensure you to reduce operational expenses drastically and help you to enhance your cash flow. All our process transactions and practices related to business are handled according to HIPPA, PHI compliances and US information security guidelines.
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Our monthly accountability reports keep you informed and in control. In fact, you will have greater control over your practice than you have ever experienced. In addition, it’s much easier to keep up with new regulations and updates. We aim at absolute satisfaction of our clientele by delivering our services with high accuracy and quality within the TAT.
ESSENTIAL STEPS
ENSURING THAT HEALHCARE PROVIDERS RECEIVE TIMELY PAYMENTS
1. Appointment Scheduling
The first step in the revenue cycle management process is scheduling an appointment with the patient. This involves collecting their personal and medical information, such as name, date of birth, insurance details, and reason for the visit. The demand for virtual assistants continues to increase, and appointment scheduling is one area where virtual receptionists excel.
5. Referral and Authorization
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Some insurance plans require a referral or authorization from a primary care physician or insurance company before receiving specialty care or services. The healthcare provider must ensure that the patient has obtained the necessary referral or authorization before rendering services.
9. Submitting Claims
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Once the charges have been posted, the healthcare provider submits the claim to the insurance company for payment.
12. Denial Management
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Denial management involves resolving any claim denials or issues that may arise. Healthcare providers must identify the cause of the denial and take the necessary steps to resubmit the claim for payment.
2. Patient Registration
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After scheduling an appointment, the patient must complete registration forms that include their demographic and medical information. This data is used to verify eligibility and benefits, as well as to provide accurate billing.
6. Describing Charges
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Healthcare providers must provide a detailed description of the charges incurred during a patient’s visit. This includes services rendered, medications prescribed, and any medical devices used.
10. Clearinghouse Denials
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Sometimes, insurance companies deny claims due to incorrect coding or incomplete information. Healthcare providers use clearinghouses to track and manage these claim denials.
13. Secondary filing
If the initial claim is denied, the healthcare provider may need to file a secondary claim with the patient’s secondary insurance provider. This step ensures that the healthcare provider receives payment for the services rendered.
3. Eligibility and Benefits Verification
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To determine their payment responsibility, healthcare providers must verify patients’ insurance coverage and benefits. This involves checking the patient’s insurance plan for co-pays, deductibles, and other payment details.
7. Coding and Billing
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The coding and billing step involves assigning appropriate codes to medical procedures and services, ensuring that the claim accurately reflects the care provided. This process helps to avoid claim denials or incorrect payments. With the continuous changes in billing codes and administrative practice personnel under constant pressure, ideal conditions are created where revenue can leak from the practice. This is where revenue cycle management specialists like Neolytix remain focused due to their extensive resources and expertise.
14. Accounts Receivable
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The accounts receivable step involves managing the patient’s outstanding balances. This step ensures that the patient’s account remains up-to-date and that the healthcare provider receives payment for the services rendered
4. Utilization Review
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Utilization review ensures that healthcare services provided to patients are medically necessary and meet insurance coverage criteria. This review is conducted to prevent unnecessary treatments that may result in claim denials or non-payment.
8. Charge Posting
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After billing the insurance company, healthcare providers post the charges to the patient’s account. This step ensures that the patient’s account balance is up-to-date.
11. Payment Posting
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After the insurance company approves the claim, the payment is posted to the patient’s account. This step ensures that the patient’s account balance reflects the payment received.
15. Appeal Procedure
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If a claim is denied, healthcare providers can appeal the decision. The appeal procedure involves providing additional documentation or information to support the claim and to ensure payment.
16. Patient Billing
Collections
The final step of the revenue cycle management process is patient billing collections. This step involves sending out statements or invoices to patients for outstanding balances. The healthcare provider may also work with a collection agency to collect payment.