6 Guided Steps For Effective Medical Revenue Cycle Management


When it comes to Medical revenue cycle management (MRCM), there are multiple steps to consider achieving the best practice. Today let’s have a look at few of them.

  • Patient scheduling and Insurance verification
  • Medical coding services
  • Charge entry
  • Claim checking
  • Payment processing
  • Denial management

Due to huge intricacies and multiple services, companies prefer to outsource their Medical revenue cycle management (MRCM) services. For 2020, here are some crucial changes to look out for in the MRCM industry.

1. Patient scheduling and Insurance verification :
Patient scheduling :

Delivering excellent service is crucial for all healthcare providers. Patient scheduling and appointment management seem routine but are the first to decide the service delivered by a medical center. Lengthy hold times, inadequate capture of eligibility and prior authorization requirements, and cumbersome methods can have a negative influence on patient satisfaction and referrals from physicians. Effective case scheduling begins with understanding the patient requirements by asking the right questions and determining the right strategies for the delivery of care. A well-coordinated and streamlined appointment scheduling and management process not only helps in gaining patient trust but also improves the performance of the revenue cycle.

While proactive engagement with patients through an online portal and automated reminders can reduce the patient no-shows, on the other hand, appointment management helps providers to better manage their schedule to reduce the long wait-time.

Insurance verification :

Case listing and Insurance verification begin with billing. Saving your hard-earned income is a priority, and so is record management for verification. Patients must perform a timely check on their insurance validity as there is a huge risk or loss to investments, materials, and time. This is why practices go to great lengths to ensure a patient’s insurance is verified well before an appointment. If he or she isn’t covered, the procedure isn’t done. It is easier and better to consider Insurance verification and provider enrollment at the beginning of the revenue cycle. When scheduling patients, case enrollment verification must become a standard part of the process alongside insurance verification.

2. Medical Coding Services :
Automated Medical Billing

Medical billing is online and automated these days and is better handled through web and cloud-based software. Using a billing software helps in effective streamlining of billing activities right from the claim submissions to managing insurance and patient payments. Also, there is reduced risk as potential errors are flagged in advance. Medical billers must be proficient in using advanced technology so that the claims are error-free.

Virtual Medical Care

To bridge the gap between the patients, doctors and nurses, the unification of digital and communication technologies is the trending solution to adopt or follow. Through this process, patient management and coordination are done in the most effective method. Also, the process brings good ROI as it involves value-based care and compensation from a fee-for-service model. The billing shall differ from a virtual patient to a patient who physically visits the facility. Medical billers also need to be aware of the proper codes applicable and telemedicine guidelines for each payer and check whether the patient’s insurance covers telemedicine to have a smooth reimbursement process. The medical billing service market will continue to grow in 2020 as there has been an increase in healthcare expenditure, internet and IT usage, and huge demand for risk and compliance management. For a successful medical billing and RCM, healthcare companies are opting to outsource these services to experienced companies for better ROI and market growth.

3. Charge Entry :

In the medical billing charge entry process, patient records are assigned with the appropriate amount as per the coding and fee schedule. The charge list will decide the doctor fees. Therefore, utmost care must be taken to avoid any charge entry errors, which otherwise may lead to claims denial. For better results, excellent co-ordination between the coding and the charge entry team is suggested.

4. Claim Checking :

Claim submission and verification must be in accordance with the service done to the patients. Any stay or improper claim might result in delay or denial in payment releases. Automated payment software offers invaluable support in this situation. Through the software, you can either submit a single claim or do it in batches. Software’s have in-built options to identify defects and report them, so you can quickly fix the problem by resubmitting the claim. Accelerating the flow of revenue in your organization will be easier, when you gain stronger control over your claims and have tools in place to weed out common errors. Claims created as such must be submitted to either the insurance provider, a clearinghouse or other claims vendor.

5. Payment Processing :

After the claim is successfully submitted and reviewed, the payment is posted for the patient to pay the bill. Payment Processing software or tools can help to generate automated billing statements. Also, we can send messages to patients electronically with a call to action button as “click here” to pay option for quick and hassle-free payments. Billing over networks like this is done via Electronic Data Interchange (EDI). Two modes of payments are extensively used to simplify patient collections.

  • Mobile
  • Online payment 

It’s also important to consider the needs of your staff to fulfill basic requirements like automatic posting and reconciliation.

6. Denial Management :

Reports state that claims are hugely denied when services are rendered out of the department or concerned facility. It is always advised to keep a check on your organization’s periodic revenue reports. Too many denied claims can have a huge impact on your revenue and a situation as such needs to be addressed immediately. Properly executed denial management will boost earnings if revenue has lately been slow because of problematic claims.

Including the process of denial management in your billing or revenue cycle or outsourcing this service to an experienced provider can help you recover that revenue which might otherwise have remained overlooked because of insurance being filed incorrectly. In the process, you might uncover or observe certain patterns, such as more denied claims occur when billing problems arise for certain types of procedures or members of your patient population.

Conclusion :

Maple Software adopts an active approach to improve the quality and service of the healthcare organizations in critical areas like medical billing, coding, account receivables, and more through our medical revenue cycle management services.

With Maple Software’s Medical Revenue Cycle Management services, provider groups can:

  • Save Costs
  • Gain huge profits
  • Increase focus on patient care
  • Efficiently manage their practice
  • Stay ahead in the healthcare industry
  • Achieve HIPAA compliant security & Disaster recovery strategy