Revenue cycle management in healthcare typically starts with the first step of the patient making an appointment with the hospital and ends when all claims are processed.
Checking the eligibility and verifying the insurance are two essential factors to ensure the insurance coverage and determining the patient’s responsibility to pay for their healthcare services
It is a check to go through if the insurance company agrees to cover certain prescribed medications or medical procedures. Authorization is also known as precertification and it is required only for certain services
Coding Audit in healthcare organization is the determination of the medical coding policies and procedures. It is a review and analysis of submitted and prebilled claims
Most Insurance companies collect co-payment collection at the time of service at the healthcare organization. It is the responsibility of the healthcare staff to check the eligibility of the patient with the insurance taken and collect the co-payment
Electronic Medical Record (EMR) is being used in the healthcare organization to maintain, organize and retrieve the medical records of the patients. An EMR is usually used in a single provider’s office
The payment processing team decides in transferring pending balances if any to the insurers and resolves the credit balance issues
Business Intelligence converts raw data into useful and understandable data. BI is constantly revolutionizing the healthcare industry and working towards betterment
. Credentialing is involved in the hiring process in the healthcare organization. The check is carried over by a specialist or electronic service
Data Analytics is a very important process which analyses and focuses on patient records, diagnoses, cost and many more in order to gain insights and helps in decision-making of the healthcare organization
The contract includes benefits, compensation, conditions of termination and a lot more. Contracts are essential in all industries to avoid certain unnecessary problems as these documents stand as a proof as and when required
It is the responsibility of a patient with an HDHP (high-deductible health plan) insurance, to pay the medical bills on their own until their deductible is met. HDHP covers only accidents or emergencies and results in high out of pocket costs
The call centre professionals act as a liaison between the patient and the healthcare organization and are expected to know all the necessary information about the hospital. Call Centre in the healthcare organization is an added advantage as it renders numerous benefits
Revenue Cycle Management plays a vital role in accounting as RCM refers to the financial process to track the revenue of the healthcare organization.