When considering hiring a remote medical billing service partner, you might find yourself wondering how the process works especially if you’re new to owning a practice or to the billing process in general.

The good news is, whether remote or in-house, the revenue cycle management process is the same.

Step 1: Patient registration and scheduling. 

This is a simple, yet incredibly important step as this is when you’ll capture critical patient information for billing purposes. Your registration and scheduling process should include the following items at a minimum:

  • Patient’s full name
  • Patient’s date of birth
  • Patient’s social security number
  • Patient’s demographics: sex, race, address with zip code, phone number
  • Patient’s health history (this can be important during the physician or provider diagnosis and coding)
  • Patient’s primary insurance carrier name, ID, and group ID (if applicable)
  • Patient’s secondary insurance if applicableName of the primary insurance holder
  • Current symptoms
  • Home treatment or prior treatment by another medical professional

With the walk-in nature of many clinics, physician offices, and emergency rooms, it is important to capture as much information as possible to ensure coders have the appropriate information required to accurately code the patient’s visit. If your practice or organization also provides virtual doctor visits, it is still important to have the patient submit the required information to ensure proper and accurate coding of their visit.

Step 2: Eligibility and Benefits Verification

During this step, the patient’s benefits are verified through their insurance carrier. This process will determine if the patient’s visit will be processed as in-network or out-of-network, and the level of coverage for their visit and treatment provided. It is at this point you will determine how much the patient will need to pay at the time of their visit.

Step 3: Prior Authorization and Co-pay

Depending on the patient’s insurance carrier and their level of benefits, their insurance carrier may require prior authorization of treatment. If this is true, taking the time to explain this to the patient is very important as the results of prior authorization will affect the payment of the insurance claim. It is also at this step that you will take the patient’s required co-pay.

Step 4: Patient Exam/Treatment

During this step, physicians should provide detailed notes about the patient’s prior health issues, the onset of their symptoms, any at-home treatment, their observations, and treatment administered. The more specific the physician can be in their exam and treatment notes, the more accurate the coding will be. For example, if a patient has a headache, rather than documenting “headache” the physician should include where the patient is feeling pain and the intensity of the pain, i.e. center of the forehead and under both eyes near the sinus cavity.

Step 5: Coding and Charge Entry

Once a patient chart has been completed and signed, the coding and charge entry step can begin. At Gryphon Healthcare, we have specialty-specific coders because they are better able to interpret and understand the nuances of a physician’s notes. This level of focus allows the assignment and entering of the most accurate codes, resulting in fewer denials and optimal payment.

Step 6: Claim Review and Submission

Once coding and charge entry are complete, the claim should be reviewed to ensure all information has been entered and then submitted to the payer. The payer then reviews the claim and either submits payment or denies the claim. Claim denials can come for a number of reasons including a misspelled name, birthdates entered incorrectly, or an inaccurate code. It is because of these reasons that the previous steps (demographics, patient insurance information, physician notes, and coding) are so important.

Step 7: Claims Management

Should a claim be denied for any reason, it is important for the revenue cycle team to make necessary corrections and then resubmit the claim. For some specialties, there is only a short window of time for corrections and resubmission so it is important that claims are monitored on a daily basis. There are also times that a payer may respond to claims with requests for more information from either the provider, facility, or the patient. To ensure these claims are processed, the revenue cycle team should promptly respond to these requests and work with patients to help them provide the necessary information. Any delay in resubmission or response for more information could result in a denial or zero payment from the payer.

Step 8: Patient Statements and Collections

Once claims have been submitted and managed, generating patient statements in a timely manner is the best way to ensure you receive payment to help optimize your revenue cycle. Following up with patients to collect patient responsible balance is the final step. There are several ways you can make receiving patient payments easier for the patient. After all, you don’t want to create roadblocks to receiving the money you’re owed. The use of online payment portals and text message or email statements that include QR codes for easy payment are ways to make this process more patient-friendly.

A remote billing service is a great way to optimize your revenue cycle and can cost less than you think. In fact, we actually think it can help you save money! We’ve put together a white paper that details how working with an outsourced revenue cycle management partner can help you save time, energy, and money. You can get this white paper sent straight to your inbox here!