Understanding Revenue Cycle Management (RCM)
Revenue Cycle Management (RCM) is the vital process that ensures the financial health of healthcare services from the moment a patient steps in until the final payment is received. It’s more than just a series of billing steps—it’s a comprehensive strategy to secure timely and accurate reimbursement for the care provided.
It might sound straightforward—just a sequence from billing to payment. But if you’ve ever been involved in RCM or managed a medical practice, you know it can quickly turn into a complex balancing act where every solved issue seems to lead to another challenge.
At Applied Medical Systems, we simplify this intricate process by meticulously managing every step of the revenue cycle. Our goal is to alleviate the administrative burden on your practice and ensure smooth, efficient operations.
Here’s how we do it:
- Patient Registration: We assist with collecting and verifying patient information and insurance details, ensuring that billing is accurate from the start. We also offer training for front desk staff to enhance their efficiency.
- Insurance Verification: We assist the front desk to confirm the patient’s insurance coverage and thoroughly understand the plan’s benefits and limitations to prevent unexpected issues.
- Coding: Our certified coders, accredited by AAPC or AHIMA, expertly translate medical procedures and diagnoses into standardized codes (ICD, CPT) used for precise billing.
- Charge Capture: We meticulously review the services and procedures provided before claims are submitted, ensuring all charges are accurately captured.
- Claims Submission: We handle the preparation and submission of claims to insurance companies, facilitating timely reimbursement. We utilize rule engines built into EHRs and Clearinghouses to fix as many claims as possible on the front end.
- Payment Posting: We apply payments from insurers and patients to the correct accounts while identifying and analyzing trends.
- Denial Management: We address and appeal denied claims to secure the payments you deserve, handling all types of denials with expertise.
- Patient Collections: We manage the collection of any remaining patient balances, including co-pays, deductibles, and out-of-pocket costs.
- Reporting and Analytics: Even after payments are collected, our work continues. We analyze financial data to evaluate the effectiveness of the revenue cycle, uncover denial trends, detect under-payments, and identify areas for improvement.
And then, we seamlessly start the process all over again—constantly refining and optimizing the revenue cycle to ensure your practice’s financial success.
Partner with Applied Medical Systems and experience a streamlined, efficient revenue cycle management process that allows you to focus on what you do best—providing exceptional patient care.