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PATIENT REGISTRATION: Patient schedules appointment for treatment, information like client demographic, insurance card and reason for visit is gathered.
RECOMMENDATION AND AUTHORIZATION: Based upon client see reason, provider requirement to look for pre-auth and PCP referral prior to client check out.
Collection of Co-Pay/Balances: Throughout client check out, patient require to deposit any co pay balances and services are rendered to client.
MEDICAL CODING: Post treatment medical coders transform client disease deceases to diagnosis code and company services to procedure code according to ICD 10 standards.
CHARGE ENTRY: After coding, Charge entry team appoints proper dollar worth for each procedure code according to appropriate charge schedule.
CLEANING HOME: clearing home scans all info like service provider and patient demographics and forward electronic claims to insurance. Any mistakes in claim will be declined and it will not be forwarded to payor.
PAYMENT POST: Payor process the received claim and pay to service provider through check, EFT or VCC. EOB will be sent out to supplier pay to deal with in addition to payment proof. This payment are published in client’s account.
BALANCE DUES: Accounts receivable team is accountable to follow up on claims that are rejected by insurance for various factor, resolve the concerns that rejects the claim and bring payments from denied claim.
COLLECTIONS AND CHANGES: Any patient responsibilities in account are gathered from client and Any modifications on claims, will be changed by provider.
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I’m making these videos to comprehend US health care RCM at fundamental level.
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