What Does Revenue Cycle Management Company Do?

What Does Revenue Cycle Management Company Do?

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Are admin obligations hindering the performance of your practice? Ifyes, then you are not alone! Most practitioners running their own practice will agree that growing a practice is like growing any other business!

Admin tasks like patient pre-authorization, claim generation, insurance follow-up, and managing claim denials can eat away valuable time you should be spending taking care of patients and growing your practice.

While a provider’s priority is to ensure quality care, it is still essential to focus on revenue generation to keep the practice running. This means making sure billing-related activities are correctly handled, which is often a challenge for providers, particularly when running a busy practice. For this reason, the majority of providers are hiring a revenue cycle management (RCM) company to ensure the financial health of their practice.

What Do Revenue Cycle Management Companies Do?

In a nutshell, the revenue cycle management companies ensure that healthcare providers get paid correctly and quickly for the rendered services. To facilitate this, these companies have trained staff who process, submit, and follow up on health insurance claims on behalf of your practice to help you save time and generate more revenue.

The employees hired by RCM companies know the specific rules and policies of individual payers, which reduces errors during claim processing, resulting in cleaner claims and faster settlement. Your RCM partner will also pursue delinquent accounts and follow up on rejected/denied claims.

From claim generation to coding to insurance follow-ups, here are some of the many activities an RCM company will handle will you:

1. Patient registration: The RCM companies collect necessary information about a patient, including name, date of birth, and the reason for the visit. Insurance information, such as the insurance provider’s name and the patient’s policy number, is also collected. Using revenue cycle management software, the staff will check the patient’s insurance eligibility to determine which services and procedures to be rendered during the visit are covered. These checks help in easy payment reimbursement from the payers. If there are some procedures or services that will not be covered, the patient is informed about those costs’ financial responsibility.
2. Code scrubbing: Once the patient checks out, medical notes, reports, and diagnoses are translated into codes by a medical coder, and a “superbill” is compiled. Each diagnostic note is coded with CPT and ICD-10 codes to enter into the billing system. The experienced staff at RCM companies take care of the code scrubbing process with high levels of diligence and accuracy.
3. Claim generation and submission: The medical biller uses the superbill to generate a medical claim and checks it to ensure accuracy and compliance with insurance providers’ policies and HIPAA standards. This claim is submitted to the patient’s insurance provider. In addition, to claim generation and submission, experts at RCM companies can interpret and prepare the explanation of benefits (EOB) received from insurers. This means, when patients have questions, these billing specialists are the most capable people to answer them.
4. Coordination: After submitting the claim, the billing experts at RCM companies follow up with the insurance providers to eliminate unnecessary payment disbursement delays. In case claims are rejected or come back unpaid with instructions for readjustments and resubmission, billing specialists are responsible for doing the necessary research, correcting mistakes, preparing appeals as necessary, and handling the situation efficiently. These RCM companies, in addition to handling rejected and denied claims, also follow up on delayed claims to make sure providers receive maximum reimbursement as quickly as possible. After payment is made, most RCM companies provide auditing and analysis of payment information to help you determine the potential for growth and areas of improvement.

Conclusion

Ensuring the financial health of a private practice is essential for running it efficiently. The revenue cycle management experts at Alta Medical Management Company understand the nuances of billing for practices, delivering the expertise and comprehensive range of  practice management solutions designed to resolve the most complex revenue cycle management issues. Contact us today to understand how partnering with us will improve your practice’s financial health.