How Medical Billing Connected to RCM
Without properly processed medical billing the reimbursement process might get stuck. So the paperwork is the key to the revenue cycle. In this connection, it is important to process the medical information in the right way so that the doctors, nurses, therapists, lab technicians, etc are compensated rightfully for their respective services.
The medical information that is necessary for documentation includes:
- The category of disease
- The medical procedure conducted
- The medical supplies or equipment used
The two most important elements of the healthcare system are Medical Billing and Coding which ensures rightly tracked information received from the healthcare providers and insurance companies.
The work of medical billing and coding is done by qualified and experienced medical professionals who can read, interpret, record, and track complex health care information competently.
Medical coding is the method of taking the information following the diagnosis, processes, treatments, medicines, etc. Later, they are translated into alphanumeric codes that are indispensable for reimbursement. It economically or efficiently brings revenue for the company.
Medical coding is an indispensable task as the entire reimbursement that streamlines the revenue cycle depends on correct medical coding based on the diagnosis and treatment given to patients.
Both big and small medical practices see a steady stream of patients and more so, in times of ongoing Covid pandemic. The medical practices should integrate hospital billing system software not only for increasing the progress of work but to ensure that claims are properly processed and submitted and payments are collected on time rather than claim rejection.
Some steps are essential for effective medical billing.
- Patient Check-In or Registration
The first and foremost step of the system is to pay close attention to the patients’ details, like the patient’s gender, age, address, and phone number. Insurance-related information is the key to the method of registration. It includes:
- Name of the payer
- Insurance plan
- Policy ID or number
- Insurance Verification
Patients must confirm all the information about insurance information and eligibility in every appointment, and visit the medical practitioners as an insurance plan. The coverage status can be changed whenever. The healthcare provider should ask and double-check the medical billing procedure as it can have a direct influence on the claim regarding dealing out and ensuing claim settlement.
- Patient and health provider meet
During the “meet” the patient generally lets the providers know about the symptoms and medical problems. Next, the provider collects all the relevant information and decides in respect of the necessity of the appropriate treatment. The meeting might be held either in audio or in the video. It is recorded to ensure for right details and the diagnosis.
- Medical Transcription
A qualified and experienced professional accurately documents all the details in the medical script which is used later for maintenance and updating the patients’ data when they come to visit the doctor again. This step must be foolproof because a slight mistake in medical billing can lead to faulty decisions and leads to claim rejection.
- Charge Entry
The expenses gained to render the service is added to the amount calculated by the medical coder. This is the first step in preparing the medical billing claim form that needs to be submitted to the insurance company. It must be of an accurate amount, or else the payment cannot be collected.
Once everything is prepared about the patient information, finally the claim is ready for submission through electronic a format called ‘Electronic Data Transfer .