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Overview RCM

RCM Overview

RCM is the financial process, utilizing medical billing software that healthcare facilities uses to track patient care episodes from registration and appointment scheduling to final settlement of doctor visits

RCM unifies the business and clinical sides of healthcare by coupling administrative data such as patient's name, insurance provider & other personal information with the treatment patients receive and their healthcare data.

Communicating with health insurance companies is a key component of RCM industry. When a patient schedules an appointment, the physician's office &/or the hospital staff typically check the patient's reported insurance coverage before the visit. After an insured patient receives treatment for a given condition and supplies any applicable copayment, a healthcare provider or medical coder categorizes the nature of the treatment according to ICD-10 codes. The hospital or care facility then sends the care summary with ICD and Current Procedural Technology codes to the patient's insurance company to see what portion of the care will be covered by insurance, with the patient billed for the remainder.

Revenue Cycle

Over the call enquiry/Appointment Scheduling

Patient Visit/Patient Registration in PM:

Coding: By looking into the patient chart certified coder will identify billable diagnosis and procedures

Charge Entry: rendered services will be entered in the system for billing

Claim submission: Submitting claims of billable fees to insurance companies.

Remittance processing: Applying or rejecting payments through remittance processing.

Insurance follow up: Collecting payments from insurance on unresolved AR.

Preregistration: Collecting preregistration information, such as insurance coverage, before a patient arrives for inpatient or outpatient procedures.

Patient collections: Collecting payments from patient