An effective Revenue Cycle Management (RCM) helps practices to increase efficiency and revenues. It also ensures to cut cost and reduce denials considerably. Revenue Cycle Management is not about just one activity, it is all about managing the entire process from start to finish. In the healthcare setting, Revenue Cycle Management begins even prior to a patient’s visit to the facility.

The first step in RCM

Pre-verification or insurance eligibility verification is the first step in Revenue Cycle Management. Here, all the patients scheduled to visit the provider are verified for eligibility and benefits with their insurance. All authorization and referral requirements are clearly understood and documented. Also, Co-pay, Deductibles and out of pocket expenses are documented. The first step to effective Revenue Cycle Management begins with collecting the patient liabilities immediately during the visit. (more…)

Why is Eligibility Verification Needed?

Providers lose thousands of dollars every year when services provided by them are denied as non-covered services by the patients’ medical insurance company. Usually, the providers know about these denials anywhere between 15-30 days after the services were provided. As a result, they end up billing the patient after 30 + days and need to spend more time, money and resources to collect the dues. If they are not successful in getting the money from the patient, it will usually be moved to a collection agency. This non-productive billing process can be elevated by adopting insurance eligibility verification.

It is standard for individuals or employers to change their insurance plans for various reasons. These frequent changes make it essential for the providers to have updated information on patient insurance coverage. Hence eligibility verification process has become a crucial step in quicker reimbursement. It reduces and, in many cases, eliminates denials. Thus insurance verification helps to increase provider revenues and weeds out uncollectible. (more…)

In these fast-paced and rapidly evolving times, providers are faced with many challenges, including reduced reimbursements, changing government laws, strict patient health information rules and more. Physicians are faced with providing excellent patient care and need to ensure they are paid fully for all the services they have provided. Providers usually hire a dedicated in-house biller or billers for their practice or outsource their billing requirements to a professional medical billing and coding company.  (more…)