Demystifying the Claims Follow-Up Process: A Guide for Successful RCM Departments
June 08, 2023
Revenue Cycle Management (RCM) is an integral part of any medical practice. It’s the process of managing and tracking the financial flows of healthcare transactions, including patient billing, payments, and collections. One of the most important steps in RCM is the claims follow-up process, which is responsible for ensuring that all claims are paid correctly and on time.
Unfortunately, the claims follow-up process can be a complex, time-consuming task for RCM departments. It requires a considerable amount of data tracking and processing, which can be tedious and time-consuming. However, with the right strategies and techniques, RCM departments can streamline their claims follow-up process, resulting in greater efficiency, accuracy, and lower costs.
The first step in the claims follow-up process is to organize and track all patient claims. RCM departments should use an automated system to track patient claims, such as an electronic health records (EHR) system or a claims processing software. This will ensure that all claims are properly tracked and monitored.
Once claims have been organized, RCM departments should review each claim to ensure that all the necessary data is present. This includes verifying dates of service, patient information, diagnosis codes, and other important information. This will ensure that the claims are correctly coded and that the patient has received the proper services.
Once claims have been reviewed, RCM departments should submit them to the insurance company for payment. This can be done manually or electronically, depending on the insurer’s requirements. Manual submissions may take longer, but they are often more accurate than electronic submissions.
Once claims have been submitted, RCM departments should monitor the status of each claim. This can be done manually or electronically, depending on the insurer’s requirements. Manual monitoring may be more time-consuming, but it also reduces the risk of errors. Electronic monitoring is usually more efficient and can provide real-time updates on the status of each claim.
The final step in the claims follow-up process is to appeal any denied or underpaid claims. This is a critical step, as it ensures that all claims are paid correctly and that the patient receives the proper reimbursement. RCM departments should review all denied and underpaid claims and submit an appeal to the insurer. This can be done manually or electronically, depending on the insurer’s requirements.
By following these simple steps, RCM departments can ensure that their claims follow-up process is efficient and accurate. This will result in greater efficiency, accuracy, and lower costs for the practice. With the right strategies and techniques, RCM departments can make the claims follow-up process a much simpler and more effective endeavor.
- Organize and track all patient claims
- Review each claim to ensure all necessary data is present
- Submit claims to the insurance company for payment
- Monitor the status of each claim
- Appeal any denied or underpaid claims