RCM Services
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E2E Revenue Cycle Management
Patient Registration
The revenue cycle gets started when a patient seeks medical services. The patient’s demographic and insurance information are collected during the registration process. This step involves verifying the patient’s insurance coverage, determining eligibility, and gathering the necessary documentation as needed.
Pre-Authorization
The healthcare provider starts the pre-authorization process if specific procedures or services need prior approval from insurance companies. Before the services get rendered, this entails submitting documentation to obtain the insurance company's approval.
Charge Capture
The charge capture phase starts up after the patient receives medical care. It involves documenting the services rendered, including the procedures, treatments, medications, and supplies. For accurate billing and coding, comprehensive documentation is required.
Medical Coding
At this juncture, skilled medical coders review the supporting documentation and assign appropriate diagnostic and procedure codes in accordance with coding standards included in the ICD and CPT manuals. The patient's condition and the services rendered are described in the coded information.
Claim Submission
The medical billers use the information that was coded to prepare claims after the medical coding is completed. The claims embody itemized lists of the services provided and the corresponding codes. After that, the claims are submitted to the appropriate payers, such as insurance companies or government programs, electronically or through paper submission.
Claim Adjudication
After the claims are submitted, the insurance companies or payers review them for accuracy and compliance with their policies. This process is called claim adjudication. The payer makes their decision on the patient's insurance plan, deductibles, co-pays, and coverage limitations to determine the amount they will pay for each service.
Payment Posting
The healthcare provider receives payment from the insurance companies or payers when the claims are settled. The amount collected and the remaining balance are reflected in the payment as it is posted to the patient's account in the provider's system.
Denial Appeals & Management
Claims may occasionally be rejected because of errors, inaccuracies, or limitations on coverage. Denial management entails looking into and addressing claim denials by adding more supporting information, correcting errors, or appealing the decision. This step aims to maximize reimbursement and minimize revenue loss.
Patient Billing
The patient is charged the balance if there is a patient responsibility portion, such as co-pays, deductibles, or services not covered by insurance. The patient receives an invoice or statement detailing the services provided, the amount due, and any outstanding balances.
Payment Collection
Getting payments from patients is the last step. This may involve a number of methods of payment, including cash, cheque, credit cards, and payment plans. The provider’s staff may follow up with patients to ensure timely payment and handle any inquiries or disputes.
Accounts Receivable Management
The handling of accounts receivable is essential throughout the revenue cycle. It involves keeping track of unpaid bills, monitoring aging accounts, and following up on unpaid claims or patients.
Why TrellisTract:
TrellisTract offers a specialized back-office team with end-to-end services to meet your needs head-on. We provide solutions, not services.
Facilitate organic growth
Cut back on operation expenses
Get In Touch With Us
We’re excited to discuss how TrellisTract can transform your healthcare revenue cycle. Whether you have questions, need a consultation, or are ready to take the next steps, our team is here to help.