Our Process | BLOG - Revenue Acceleration LLC

Our Process

Our Process

Revenue cycle management (RCM) involves a series of steps that looks at potential problems and opportunities for enhancing revenue for a hospital. The entire revenue cycle starts from a patient’s admission to the hospital, treatment and discharge to post discharge claims and account settling.

We integrate our process into yours:

  • Documentation at the Front Desk.
  • Scanning Demographics, Super bills sent to billing office. Billing Office scans and saves image files to an FTP site.
  • Pre-coding – Pre-coders then enter the key-in codes for insurance companies, doctors, referring doctors, modifiers, diagnosis codes and procedure codes that are not already in the system.
  • Coding – The Coding team assigns the Numerical codes for CPT (Current Procedural Terminology) and the Diagnosis Code (ICD) based on the description given by the provider.Pre-coding – Pre-coders then enter the key-in codes for insurance companies, doctors, referring doctors, modifiers, diagnosis codes and procedure codes that are not already in the system.
  • Charge Entry – Entering the patients personal information from the Demographic sheets. After checking & relating the ICD and CPT, charge is created.
  • Auditing – The daily charge entry is then audited to double check the accuracy of the entry, in regards of the billing rule. Also this department verifies the accuracy of the claims based on carrier requirements to be sure we have a clean claim.
  • Claims Transmission – Claims are then filed and sent to the Transmission department. The transmission department prepares a list of claims that need to be sent on paper or through electronic media. Transmission rejections are analyzed and appropriate corrective action is taken.
  • Carrier Adjudication – The carrier would then review the claim for adjudication and processing for payment. Then the check and Explanation of Benefits (EOB) is sent to the provider.
  • Cash Applications – The cash files (copy of Check & EOB) are applied towards the payments in the billing software against the appropriate patient account.
  • Denial Processing – The claims denied or suspended due to any reasons need to be worked over to receive a payment in time. Appropriate denial codes are keyed in and sent back to the carrier for reconsideration.
  • Patient Billing – The patient balance i.e., deductible, co-pay or coinsurance is billed to the patient looking forward to payment.
  • Accounts Receivable Collections – These handle the old accounts that remain in suspension for more than 90 days. They make follow up calls with the Patient, Provider & Insurance to fill up the missing details in the claim. If the patient is responsible for any payment including the deductibles they make the necessary calls to the patient to collect the amount, following billing.