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How Some Medical Offices Handle Claims and Tips to Streamline the Process

A revenue cycle management system is a process that healthcare facilities use to track their services and payments. It is a complex operation, and most offices use software to organize the process.


The cycle begins when an individual makes an appointment. The scheduler logs the details into their system. The staff will capture the person’s details, insurance information, and gather all the necessary paperwork. Although this may seem like a small step, it is vital to the overall flow. Any errors, such as misspellings or wrong birthdays, can cause a lag in services and payments.


Once the visit is over, the billing department will send the claim to the insurance. The medical biller will need to input the correct codes in order for the doctor to get reimbursed correctly. Billers can quickly drop in repetitive and routine codes if they use an automated platform.


Once the insurance receives the claim, its team will review it. Several things could occur. The claim could be paid, rejected, or the payment amount could be wrong. The office needs to ensure that they are fully compensated for each visit. When an insurance company denies something, the medical billers need to investigate the matter and contact the patient.


One of the most efficient methods to keep this process flowing is to utilize technology and trained professionals. A medical facility should use protocols that begin with new patient input and end with settlements. The management can support the clerical staff by updating the company’s software and providing adequate training.