Basics of Healthcare Revenue Cycle Management

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• Basics of Healthcare Revenue Cycle Management

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Basics of Healthcare Revenue Cycle Management

• The noble cause of saving lives and treating
  patients is the prior most aim of the healthcare
  providers like doctors, physicians, imaging
  centers, emergency and intensive care centers,
  pharmacies, etc. Perfect financial management,
  tools and techniques to meet inevitable crises
  and expertise are needed to run and flourish the
  healthcare industry smoothly.
• So, the healthcare revenue cycle management is
  all about this management of administrative and
  clinical tasks to deal with the processing of
  claims, payments, generation and collection of
  revenue. There is no other way for healthcare
  providers to pay their bills and cater to the
  needs of patients without this revenue cycle
  management.
• The Process of healthcare revenue cycle
  management
• An appointment for a medical service is made by
  the patient. Further creating and verifying the
  patients account, scheduling and insurance
  ability requirements are done by the
  administrative staff
• The pre-registration process involves getting the
  medical history and insurance coverage to create
  the patients account
• The patient can go through the actual medical
  service or procedure sometimes prior
  authorization approval is needed
• The claim is eventually created and forwarded.
  Wherein, using the appropriate ICD-10 codes, the
  nature of treatments received can be identified
  by the functional coder

Medical Billing Services in Oregon
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Basics of Healthcare Revenue Cycle Management

• As per applicability, the private or government
  payer receives the claim for reimbursement.
  Still, the back-end processes of statement
  processing, handling the collections and claims
  denials are to be dealt with
• Evaluation of the claim occurs. Here, the
  reimbursement based on the patients coverage and
  payer contracts is done to the healthcare
  organization for their services. But, improper
  coding, missing items, or/and incomplete
  patients account details may lead to the denial
  of claims.
• Apart from the coverage, the patients are liable
  to pay the charges for the services rendered and
  the materials used in the procedure that are not
  included in the coverage
• The revenue cycle management should be so
  excellent so that the complete and hassle-free
  reimbursement or payment must be achieved by the
  healthcare management for the services provided.
• What happens actually?
• Perhaps, sometimes the scenario is exactly the
  unexpected wherein, the healthcare back-end staff
  has to work exclusively for claim settlements and
  payment issues. The shortage of in-between time
  and the utmost care they provide to the patients
  leads them to deal with such unexpected
  situations.
• Ways to tackle this
• Here comes the assistance of the role of the
  medical billing service provider. They can be
  hired at affordable prices for the best-suited
  service provided to run the revenue cycle
  management smoothly with the best options and
  solutions whenever needed.

Medical Billing Services in Oregon
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Basics of Healthcare Revenue Cycle Management

• To achieve an outstanding position, unmatched and
  clear prices for services, top-level clinical
  outcomes and effective billing and collection
  process is a must at this hour.
• Revenue can be lost if the identification and
  resolving of issues are not done timely. An
  automated alert system can be designed to address
  the reason for unexpected claim denials by the
  patients.
• To empower the revenue cycle management, alloying
  the technology and utmost human vigilance with
  the revenue cycle is the topmost priority.

Medical Billing Services in Oregon