Deciding how to handle your processing is the first step to the cycle. How big is your medical
organization? If you are fairly limited in scope and have a good IT team in place as well as team
members who are well versed in using dedicated software for medical billing, you may prefer to install
RCM software on your own servers.
However, if you run a larger organization, such as one with satellite offices, the best approach might be
to outsource the RCM process to third party experts. Practices with limited staff expertise in RCM will
also find it beneficial to rely on outsiders for this task, so they can focus on their core capabilities in
patient treatment
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The next step in RCM is the pre-authorization of each patient. Pre-authorization is defined by the U.S.
government as a decision by a health insurer or plan that a prescription medication, procedure, service
or equipment is medically necessary. The exception to pre-authorization would be in cases of medical
emergency.
It’s important to remember that pre-authorization for a procedure or medicine does not necessarily
mean that the insurer will cover its cost, though. Patients and providers have to double-check if there is
any doubt about coverage.
Some of the drudgery of your front office staff has to do with checking on eligibility and benefits for
patients. When done over the phone, it can be a grueling and time-consuming process that saps
employee morale.
Modern medical office software will include automatic checking of patient eligibility via the Internet
over secure channels, meaning that using dedicated RCM software can speed up the work involved in
verifying a patient is entitled to a particular benefit.
Payment will not be forthcoming until your office properly submits claims for the work you do for your
patients. Practice management or PM software is invaluable in this situation. You use it to submit claims
automatically, including the option to do this in batches. Since human error is always a factor to contend
with in submitting claims, you’ll want to deploy PM software that includes an option to detect mistakes
and then explain them to you so you can fix the problem. Then you can immediately resubmit the claim.
Accelerating the flow of revenue in your organization will be easier when you gain tighter control over
claims and have tools in place to weed out common errors
After the claim is successfully submitted and reviewed, the payment is posted and is able to be paid by your patient. RCM software can help in this respect not only in the convenience it offers for generating billing statements. You can even use the system to send messages to patients electronically with a “click here” to pay option to encourage them to reimburse you more quickly. Billing over networks like this is done via Electronic Data Interchange (EDI).
Payment will not be forthcoming until your office properly submits claims for the work you do for your
patients. Practice management or PM software is invaluable in this situation. You use it to submit claims
automatically, including the option to do this in batches. Since human error is always a factor to contend
with in submitting claims, you’ll want to deploy PM software that includes an option to detect mistakes
and then explain them to you so you can fix the problem. Then you can immediately resubmit the claim.
Accelerating the flow of revenue in your organization will be easier when you gain tighter control over
claims and have tools in place to weed out common errors
A medical practice without detailed reports is a practice that can have hidden problems that may be
growing worse. You need to generate a range of reports for your meetings. Use the RCM software to
define customized reports, including financial data, management information and key performance
indicators to see if your team is meeting benchmarks.
What’s more, when using a modern, state-of-the-art RCM system, you can generate reports at will, not
having to worry that the processing might slow down for other users. Your practice will work more
productively as a result.
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