Steps to Complete Revenue Cycle Management in Behavioral Health

The term revenue cycle management (RCM) refers to the financial process surrounding a healthcare appointment. RCM can also often be referred to as behavioral health or medical billing. No matter what name you give it, RCM takes more skills and knowledge to complete than you may think. Keep reading to learn about the steps in the revenue cycle and the benefits of outsourcing its management.

The Complete Revenue Cycle
How many steps does the revenue cycle have? The answer depends on who you ask. Many sources list about seven to nine different steps in the process. Here are nine medical billing steps to give you the full picture:

1. Charge Capture: The provider assigns their clinical services charges in a centralized system.
2. Coding: While the provider gives each service a charge, they can also match them to the proper ICD codes.
3. Pre-Registration: During their first contact with a client, the provider obtains basic clinical and financial information.
4. Registration: After pre-registration, the provider will get further information and the client’s permission to create a clinical record.
5. Claim Submission: Before requesting a payment from the client, the provider must submit a claim to the insurer using software or by contacting them.
6. Third-Party Follow-Up: If necessary, the provider will also get in touch with any third-party payers.
7. Utilization Review: The insurance company determines if the service received is covered under the plan and clinically/medically necessary.
8. Collections: Once the insurer reviews the claim, the provider can calculate the client’s bill and charge it to them.
9. Remittance Processing: After the client submits their payment, the provider reviews all aspects of the bill and accepts or rejects the payment.

The order of these steps can vary, but they all have an important role to play in behavioral health/medical billing. Making a mistake during one task can result in mistakes in further steps. Accuracy and efficiency are critical to successful RCM.

Benefits of Outsourced Revenue Cycle Management
While behavioral health/medical billing seems simple at first glance, it requires dedicated attention, resources and skills. Both small and large healthcare practices can have difficulty giving billing the care it needs. Outsourced billing services have the training and resources to complete RCM correctly and efficiently. An established RCM provider will look out for you by keeping records secure and finding ways to increase reimbursements. RCM services can complete the billing steps for you so you can focus on your clients.