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The entire interaction process between the payer and the provider is a cycle in medical billing business opportunities and is referred as revenue cycle management. In the actual term, The HFMA (Healthcare Financial Management Association) clearly defines it as the entire life of a patient account right from its creation to the payment.

The complete administrative and the clinical functions involved with the capture management and the collection of service revenue of the patient. If you are a company that is providing solutions in patient account management services, you must be specialized in reviewing the existing revenue cycle process. Medical billing is surely the process of submission and consistent follow-ups with the health insurance companies to realize the payment.

What is professional billing?

All the work performed by the non-institutional providers, suppliers and the physicians and their claims are generated for billing. It is covering both outpatient and inpatient services. The transition to a paperless model is always the mandate forward. Consistency in billing platforms and managing CMS-1500 standards should be the idea ahead.

Identify & Monitor denials

Any medical practice will tell you that lacking a focused strategy in denial management will be leaving a lot to languish. It will eventually be considered as bad debt. You will see the denials getting settled unfavorably.

Recognize existing opportunities: Field-tested methods with best practice tools will be helping a medical practice manage their denials in the best possible manner. You will have to identify the right opportunities that will prevent your medical claims to get denied by the insurers. Classifying the denials and find a reason and the source. What are the causes and the key distinguishing factors behind it? The simple question will help you in assessing and develop an actionable plan for an effective strategy in denial management.

  • If you are looking to ensure a healthy bottom line, you have to work on the denials that are getting translated to loss of revenue. A streamlined process is necessary that will engage the patients and the referring physicians with the others to reverse the unfounded denials.
  • It is true that unpaid services will be the denied claims. It is lost or deferred payment for your medical practice. It is important to note that it is also signified an avoidable area of cost.
  • The complexities in the federal regulations will be asking healthcare providers to establish their credentials by being transparent in the service process.

It will sap your important resources from the business office and your employees will be seen managing and getting an ideal resolution! How are they going to resolve denials?

The denial reason

When you will have your adjudicated medical claims returned not being paid, there is also a reason behind it. The insurance will indicate the reason for the denial. The key indicators, claims adjustment reason codes (CARC), that can be further explained in remittance advice remark code (RARC) need expert perspective. Someone that understands modern payer mindset, the functional best practices required in medical billing.