ELEVATION US HEALTH CARE
Elevating RCM, Elevating Healthcare
What Is RCM ?
Revenue Cycle Management (RCM) is the process healthcare organizations use to track patient care episodes from registration and appointment scheduling to the final payment of a balance. It encompasses everything from billing and coding to handling claims and managing denials, ensuring that healthcare providers get paid promptly and accurately for their services.
Do More With Your Revenue Cycle
Medical Transcription
Denial & Appeal
MEDICAL CODING
Medical Billing
CHARGE ENTRY
AR FOLLOW UP
THREE PILLARS OF MEDICAL BILLING
Patient:
The patient received treatment for the illness.
Provider:
The Physician who furnishes the services for
any disease or illness to the patient.
Payer (Insurance):
In Medical Billing terms a payer
refers to an entity that pays or reimburses for health
services rendered to the patient
HOW MEDICAL BILLING WORKS IN THE HEALTHCARE INDUSTRY ?
Medical billing is the process where healthcare providers submit claims to health insurance companies or patients to receive payment for services rendered. Here is how medical billing works in the healthcare industry.
1. Patient visits healthcare provider – The first step in medical billing is when a patient visits a healthcare provider,
whether it is a doctor, hospital, or clinic, to receive medical services.
2. Healthcare provider documents services – After the patient is seen by the healthcare provider, the provider
documents the services rendered, such as medical examinations, procedures, tests, and medications.
3. Claim submission – Healthcare providers submit claims electronically or on paper forms to health insurance
companies or patients for payment. The claim includes the patient’s personal information, the healthcare
provider’s information, the services rendered, and the charges associated with those services.
4. Insurance verification – Health insurance companies check the patient’s coverage for the services provided.
This process allows them to determine how much to pay for the claim and how much the patient owes.
5. Claim review – Health insurance companies review the claim for accuracy and completeness, ensuring that all
required information is included.
6. Adjudication – This is the process where the health insurance company calculates how much
they will pay for the services rendered.
7. Payment – After the adjudication process, the health insurance company releases payment
according to the agreed-upon amount.
8. Patient billing – If the patient has a deductible or copayment, they receive a bill for the
remaining balance. The healthcare provider will send the bill directly to the patient or the
insurance company.