Revenue Cycle

In order to remove unwanted costs and inefficiencies from your practice, an understanding of the revenue cycle must be achieved. Below you’ll learn the basic, but necessary steps needed to shorten the revenue cycle and produce optimal results.

 

Insurance Pre-Authorization and Benefits should be obtained prior to patient’s appointment

  • Obtain and verify demographics
  • Obtain insurance authorizations

Patient Check-In

  • patient co-payments
  • reconcile account balances

Charge Entry & Capture

  • service capture(charge tickets)
  • insurance documentation
  • identify CPT and ICD-9codes
  • identify necessary modifiers
  • review chart and code claim and/or operative notes

Claim Processing

  • electronic submission
  • generate patient statements
  • review and edit/submit claim

Payment Posting

  • post & balance payments
  • denials, refunds & appeals
  • prepare secondary claims

Follow Up

  • request additional info
  • update claim status
  • payment progress reports

Denial Management

  • "clean claims" paid and posted
  • if not clean, claims reviewed, edited and resubmitted
  • claim appeals process
  • submit necessary insurance appeal

Collections

  • collect remaining insurance payments
  • collect patient payments
  • review and collect aging A/R

Quality Control

  • benchmarking
  • review receipt flow
  • review A/R flow

 

 

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