revenue cycle management services | XyberMed

Revenue Cycle Management Services

By industry standards, revenue cycle management (RCM) goes beyond the basic billing function to encompass claims processing and denials management, patient payments, medical coding and billing, and revenue generation. Therefore, it would not be an understatement to suggest that RCM is the lifeline of any medical practice.

Unfortunately, many healthcare professionals confuse RCM with their practice's medical billing business.

Improving revenue stream depends primarily on time management and practice workflow, which begins at registration, where patient insurance eligibility is determined and co-pays are collected. It ends with the correct coding of claims using ICD-10 and submitting them on time. An efficient billing system is also an important benchmark for successful revenue cycle management. This can be achieved by implementing the right EHR and practice management system or outsourcing revenue cycle management to a reliable vendor.

Practice RCM Workflow Patient scheduling and eligibility verification The intake cycle begins the moment the patient calls to make an appointment with the practice. The front desk staff must necessarily be adept at dealing with new and returning patients. In the event of a new patient, it is essential to accurately collect and verify the patient's demographic and insurance data. In the event that this data is mistaken, claims will be rejected immediately. Similarly, in the case of a returning patient, check for any changes in data and remind the patient of previous nonpayments, if any.

Patient visit and clinical documentation Patient clinical documentation should be complete and conform to the requirements of CMS guidelines. Must integrate the documentation process into the daily decisionmaking process to ensure that the patient record is complete and meets ICD-10 coding standards.

Superbilling is completed by the provider.

This is the most critical phase of the revenue cycle management workflow. The physician will receive payment for services rendered based on the information shared on the superbill, which should provide details of the diagnosis and procedures performed on the patient, along with the correct CPT and ICD codes.

Patient payment and collection of co-payments Collection of co-payments at the time of registration is usually the best practice at the front desk. However, in the event of a patient emergency or at peak times, patients may be asked to pay before leaving the office.

Coding and billing Physicians should have a CMS-certified EHR, an immunization administration system, and a practice management system that allows them to essentially code with ICD-10.

Due to the complexity of the codes, practices must hire professional coders to ensure claims processing on the first submission.

Creating an accurate claim is the most crucial phase of the workflow. A practice's revenue depends on the acceptance of submitted claims. Therefore, it is very important that claims have accurate details and are submitted on time.