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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 rightly addresses the complicated regulations that medical providers face to get paid for critical or routine health care services. To ensure that there is cash flow in a sector where reimbursement is highly controlled, dentists and physicians should hire individuals with particular RCM skills. Efficient management of medical receivables is made possible through contracting competent companies. The big insurance providers and Medicare cater to the bulk of the healthcare in the States. The percent not paid for by the insurance companies is covered by patients. With the higher growth in high deductible health plan use, the balances that patients pay are going higher. Both these components of account receivables have to be managed through a time-sensitive and comprehensive process.

Medical receivables management doesn’t start after a patient finishes their visit or whenever the patient signs in for an appointment. Effective RCM begins when the patient schedules an appointment and ends when the individual pays for any amount not paid for by the insurance companies.

There are the main parts of RCM, and each is vital 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 policy claim that has the proper diagnoses and treatment processes is then submitted to the correct payer electronically through some known criteria 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 giving priority to those unpaid claims by the payer, amount, and motive, the representatives of the accounts receivable may review and get in contact with the patients and payers according to the to the status or request for payment.

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.