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Revenue Cycle Management

This document discusses revenue cycle management (RCM) in the healthcare industry. It describes the medical billing process, which involves registering patients, confirming insurance, checking patients in and out, preparing claims, transmitting claims to insurance companies, monitoring patient insurance, generating statements, and following up on payments. It outlines the key steps in RCM, including performing medical services, generating records, checking patients out, processing claims, and tracking payments. The document emphasizes that effective RCM requires technology, trained staff, consistent processes, preventative approaches, dedicated accounts receivable management, and patient education. It also lists some common RCM software programs and discusses durable medical equipment billing.

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Jarjitha A
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2K views12 pages

Revenue Cycle Management

This document discusses revenue cycle management (RCM) in the healthcare industry. It describes the medical billing process, which involves registering patients, confirming insurance, checking patients in and out, preparing claims, transmitting claims to insurance companies, monitoring patient insurance, generating statements, and following up on payments. It outlines the key steps in RCM, including performing medical services, generating records, checking patients out, processing claims, and tracking payments. The document emphasizes that effective RCM requires technology, trained staff, consistent processes, preventative approaches, dedicated accounts receivable management, and patient education. It also lists some common RCM software programs and discusses durable medical equipment billing.

Uploaded by

Jarjitha A
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Revenue Cycle Management

&

DCM Process in Medical Billing


By
A.Jarjitha parvin
2nd year MBA
Medical Billing
Medical billing is a payment practice within the United
states health system. It involves a process of a
healthcare provider submitting, following up on, and
appealing claims with health insurance companies in
order to receive payment for services rendered; such as
testing, treatments, and procedures.
HOW DOES MEDICAL BILLING
WORK?
1. Patient registration
2. Confirmation of Patient Financial Responsibility
3. Patient Check-in and Check-out
4. Claim Preparation
5. Claim Transmission
6. Monitoring Patient Insurance
7. Generate Patient Statements
8. Payment Follow-up and handling collection.
RCM IN Health care
Revenue cycle Management is the process used by
health industry in united states to track the revenue from
patients.

The revenue cycle includes all the administrative and


clinical functions that contribute to the capture,
management and collection of patient service revenue.
According to the Healthcare Financial Management
Association (HFMA)

Error in RCM leads to delayed or no payments.


Overview of RCM
Processing of an insurance claim
●
1.Medical services
●
1.Patient appointment
performed
●
2.Insurance info received ●
2.Medical records
and copied
generated
●
3.Confirmation by patient ●
3.Patient checkout facility
Stair 1
Stair2
Front
Provider’s
office
entry

Stair 4
Payments Stair3
& Follow Billing and
up Tracking
●
1.Payment or deniel received with ●
1.Patient’s data received at
EOB medical billing company and
●
2. Posted to patient’s account
●
3.Balance due forwarded to patient
accounts received
●
4.Full payment received or
●
2. Claim generated & generated
forwarded to collection
●
3.Tracking of claim
The Essentials of Successful RCM
Technology
Well trained staff
Consistency in process.
Preventive Approaches
Dedicated AR Management
Patient Education
RCM Softwares.
Dr Chrono EHR
Advanced MD
Kareo Billing
Athenahealth EHR
Nexgen office ( Medi tech)
Compulink healthcare solution
DURABLE MEDICAL EQUIPMENT
Durable Medical Equipment (DME) is a
therapeutic equipment that is prescribed by licensed
physicians to patients who suffer from
certain medical condition or illness. Equipment used for
convenience or beyond reasonable medical needs of a
patient is not covered by DME billing.

 Examples: Nebulizers, ventilators, kidney machines,


etc.,  
PROCESS OF DME IN MEDICAL
BILLING
1.Prescription
2.Verification 
3.Credentials
4.Form 
5.Documentation 
6.Codes and modifiers
7.Factory Invoice.
8.DatesSupporting documents
9.Coverage
10.Repairs claims
THANK YOU

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