RCM {Revenue Cycle Management} (Day 2) Flashcards
What is RCM?
RCM stands for Revenue Cycle Management. RCM is a cycle between Patient, Provider and Payer. There are 13 steps in it, they are:
1) Appointment, Scheduling & Pre-Registration
2) Eligibility and Benefit Verification
3) Registration
4) Encounter
5) Medical Transcription
6) Medical Coding
7) Demo Entry and Charge Capture
8) Claim Generation & Submission
9) Clearing House
10) Insurance Office
11) Payment Posting
12) AR (Account Receivable)
13) Collections
1) Appointment, Scheduling & Pre-Registration
It is a department where Patient will fix an appointment with Provider via 3 ways:
i) Call
ii) Website
iii) Direct Visit to Provider’s Office
2) Eligibility and Benefit Verification
• Eligibility is a department where Patient’s active insurance policy will be verified.
• Benefit Verification is a department where Patient’s Copay, Coinsurance, Deductable, Authorization, In-Network Hospital, Out-Network Hospital, Contracted Provider & Non-Contracted Provider will be verified.
3) Registration
Registration is a department where, Patient’s Account Number will be generated into Provider’s Software. Here Patient has to sign 5 forms, they are:
1) AOB (Assignment Of Benefits)
2) ROI (Release Of Information)
3) ABN (Advance Beneficiary Notice)
4) WL (Waiver of Liability)
5) COB (Coordination of Benefits)
i) AOB
AOB stands for Assignment Of Benefits. It is a document signed by Patient giving Permission to Insurance Company to credit the treatment amount into Provider’s account not in Patient’s account.
ii) ROI
ROI stands for Release Of Information. It is a document signed by Patient giving Permission to Insurance Company and Providers to release his medical information only for Billing purpose
iii) ABN
ABN stands for Advance Beneficiary Notice. It is a document signed by Patient, if Insurance Company will not pay the bill amount, then Patient will be responsible for the liable amount.
iv) WL
WL stands for Waiver of Liability. It is a document signed by Guarantor, if the Insurance Company and Patient will not pay the bill amount then, Guarantor will be responsible for the liable amount.
v) COB
COB stands for Coordination Of Benefits. It is a document signed by the Patient, if he has multiple plans then, he has to update which is primary, secondary, tertiary and goes on.
4) Encounter
It is a department where Patient will take the treatment or service from the Provider. Their interaction will be recorded in Dicta-phone.
5) Medical Transcription
It is a department where voice format will be converted into text/medical record format.
6) Medical Coding
It is a department where text format will be converted into medical coding format.
7) Demo Entry and Charge Capture
• Demo entry is a department where Patient’s Demographic details will be entered into Claim form from box number 1 to 13.
• Charge capture is a department where Patient’s treatment expenses, Provider details will be entered into claim form from box number 14 to 33.
8) Claim Generation & Submission
It is a department where Claim will be properly generated and submitted to the Insurance Company via 2 ways, they are:
1) Mail
2) EDI-Electronic Data Interchange
9) Clearing House
It is a third party application which acts as an intermediate and helps us to know whether the Claim will be accepted or rejected by the Insurance Company.
