Medical Coding Revenue Cycle Management Process

Touseef Riaz

May 13, 2022

Medical Coding Revenue Cycle Management Process

After the emergence of COVID-19, the medical billing industry faced significant challenges. The rapid influx of patients and increasing demand for healthcare services brought tremendous pressure to managing the revenue cycle.

Medical coding revenue cycle management is the process that manages the financial and administrative functions linked with patient registration, benefits verification, claim processing, payment collection, etc. It covers all the fundamental aspects of revenue generation. Medical codes were regularly changed and upgraded, making it difficult for healthcare institutions to cope with the fast pace of progression.

Medical Coding Revenue Cycle Management Process-ucontrolbilling

Medical Coding Vs. Revenue Cycle Management

You must know the difference between medical coding vs revenue cycle management. Medical coding revenue cycle management isn’t easy to manage in the presence of current challenges. Therefore, multiple healthcare institutions plan to outsource medical billing and coding services.

The development and alteration of medical services, procedures, equipment, and healthcare diagnosis into universal medical alphanumeric codes are known as medical coding. The implementation of correct codes is vital in the medical coding process as it ensures successful claim reimbursement for the patients.

Revenue cycle management (RCM) relates to the medical institution’s financial management that helps identify, collect, and manage incoming payments. Effective RCM improves the company’s financial performance through the intelligent use of medical data and information.

Medical Coding Revenue Cycle Management Process

There are a total of 7 steps included in the medical coding RCM process.

  • Patient Registration 

This is the first step in the RCM process. You have to collect the necessary information of patients like home address, email, phone number, date of birth, and insurance information.

Through this information, you can collect all the relevant details of patients and send them their billing information. Mostly, you have to check this information just once after meeting the patient.

Whenever a patient conducts a revisit, cross-check the insurance information again for betterment.

  • Charge Capturing 

Charge capturing is patients’ details about the service they receive sent to billing. There are two ways to conduct these steps: automation and manual labor.

Automation minimizes human effort and boosts the revenue cycle management process. The manual method is old, where the front desk injects the patient medical service information into the system and sends it to billing. Both procedures have their significant advantages.

  • Coding 

Multiple codes are included in the medical billing industry that represents medical services and diagnosis. Medical providers give insurance companies a definite reference point in codes for reimbursements.

  • Claim Submission 

After the completion of converting charges into coding, the claim is sent to the insurance provider. Every medical code has different implications and rates.

If your medical claim is effectively forwarded, the insurance provider will quickly send you payment. But if there is any detection of errors, the insurance company might send you the claim back for the proper completion.

  • Insurance Communication 

After claims submission, the communication continues with the insurance provider to receive the follow-up on the payment structure. It acknowledges medical providers about the dues that are paid and not paid. Unpaid dues need to be paid by patients.

This step is crucial as insurance companies can often delay the payment process. There can be many hurdles in this process if any error occurs in the medical coding process.

  • Patient Billing 

Sometimes, patients have to pay some medical services costs from their pockets. That specific amount is calculated after the patient insurance payment is received.

Preferably, the insurance payment of the patients should be calculated timely during the first appointment. In this way, the patient can provide you with a bill during the registration stage.

It’s vital to collect the bill at the first stage as after the patient exits, it’s difficult to receive payments.

  • Mounting Revenues 

After successfully completing the payment process, it’s time to review all the RCM processes. Conduct an analysis of the performance and timeline during this process and check what can be improved.

By improving those areas, your financial revenues will increase, and you will be able to receive payments more quickly.

Medical Coding Process

Medical coding includes these steps:

  • Access patient medical records through the safe network using VPN connections.
  • Medical coders review the documents for accuracy and divide them into batches for processing.
  • All the coding requirements are assigned according to the coding guidelines and clients’ requirements.
  • Coding is done per NCCI and LCD.
  • Quality checks are ensured.

Important Insights

Medical coding procedure requires updated knowledge of the changing nature of medical codes. Medical providers should have significant knowledge about medical coding to reimburse patients successfully.

There have been multiple claim denials due to weak revenue cycle management medical coding knowledge in the past few years. If you want to find a medical coding services company, then search for those who can improve your medical billing and revenue cycle management process.

Conclusion

So, we have gone through the process of medical coding revenue cycle management. Medical institutions must improve their medical coding and revenue cycle management process to decrease claim denial rates, improve financial efficiency, and promote automation.

It’s better to outsource your medical billing process to an experienced medical coding services company to intensify the medical billing and RCM process.

FAQs

What is medical coding revenue cycle management?

Medical coding revenue cycle management is the process of managing administrative and financial functions linked with patient registration, claims, payment, and all the aspects of revenue generation.

What are common medical coding revenue cycle management errors?

The common errors include wrong patient information and inaccurate coding.

How do you prevent medical coding revenue cycle management errors?

A few ways to prevent medical coding revenue cycle management errors are always ensuring the patient information is correct, avoiding duplicate billing, and injecting correct medical codes.

 

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