EHR systems can significantly optimize your workflow and reduce the time you spend on the healthcare revenue cycle steps. While the medical billing cycle comprises numerous steps that can take anywhere from a few days to several months, accurate billing and timely follow-up are No. 1 priorities. Most states require insurance companies to pay claims within 30 or 45 days. Conversely, payers impose claim filing deadlines that, when missed, nullify coverage. The late claim is denied without option to appeal, and the organization forfeits reimbursement. First, successful RCM hinges on remembering that each step of the cycle is linked.

“If they aren’t, you are going to have to appeal that,” said Dailey. You also need to know if you are bulk posting or line item posting, and know when a contractual obligation (CO) is not a write-off. Understanding the difference between a denial and rejection is of importance as well. Keep an eye on commonly missed charges, such as supplies, devices, injections, infusions, vaccines (administrations), venipuncture, and whether the patient is new versus established, Daily advised.

Step 7: Handle Collections

Preparing a patient for billing can help to avoid confusion and late payments. Make sure you explain the medical billing process to your patient carefully, create bills that are easy to read and understand, and clearly lay out all the payment options you provide. The back-end billing staff need to match payments to the respective patient accounts, reconciling payments against their claim and confirming that data from the ERA (or EOB) match payments. At the end of the day, medical billers need to balance direct deposits received and posted. At this point, or before patients see the doctor, billers prepare the patient’s bill. This involves deducting the amount covered by insurance from the cost of the procedure or service, factoring in copays and deductibles, and adding outstanding patient balances.

If the patient has seen the provider before, their information is on file with the provider, and the patient need only explain the reason for their visit. If the patient is new, that person must provide personal and insurance information to the provider to ensure that that they are eligible to receive medical billing cycle steps services from the provider. And yes, this principle includes something as seemingly administrative as the medical billing process. As we look toward the future of medicine, the reconsideration of billing methodology may be a route toward not just institutional growth, but your patients’ peace of mind.

Step 5: Make Sure Charge Entry Is Correct on the Claim Form

Not surprisingly, this phase of the revenue cycle in medical billing can be critical to running an efficient practice. Pre-appointment planning can help ensure that your clinicians have the time and information necessary to make the best decisions. It also helps initiate your ability to collect timely payments from the patient and insurer. Finally, since it is the first contact with the patient, it is the first opportunity to connect with your patient and ensure their journey is as smooth as possible.

The provider’s workplace will also collect copayments when patients check in or out. Copayments are continuously collected for the service, but the provider can determine if the patient pays the copay before or after their visit. Patient check-in and check-out are comparatively straightforward procedures. If the patient arrives the first time, they (the provider) will be asked to fill up some forms; otherwise have to confirm the details the doctor has on file. The patient will also be needed to give some official identification, like a driver’s license or passport and a valid insurance card. Remember that medical billing has “front-of-house” and “back-of-house” responsibilities.