In Medical coding there are 10 steps to the Revenue Cycle. The first three steps, 1. Preregister patient, 2. Establish financial responsibility and 3. Check in patient go together and are not to be overlooked. If the wrong information is entered in to the practice management system or EHR incorrectly then you will have headaches later on. Garbage in will be garbage out. So this step is important to a good clean claim.
4. Review coding compliance, 5. Review billing compliance 6, Check out patient. This set of steps is important from the clinical side as well. The physician should be properly trained in Coding systems. He/she should understand the importance of clear clinical documentation and proper coding guidelines so that the facility is not falsifying claims. Practice Managers can make this process manageable by applying templates on the paper Superbill.
7 Prepare and transmit claims. 8. Monitor paper adjudication. This is the tedious part of the process. it is so important to ensure that you have a solid check and balance system in place. In the Medical practice you have to follow up with each claim and make a note of it in your system. There needs to be a balance at all times.
Step 9 Generate patient statements. Follow-up payments and collections. This is mainly talking about capturing the lost smaller balances after the insurance company has paid. This is such an important part as well. If this is not done your practice is leaving thousands of dollars on the table.