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The Revenue Cycle Management

RedEngine Systems LLC, USA }

4/3/2014

Denise Miller

Introduction

The Revenue Cycle Management is a process that manages activities such as claims

processing, payment and revenue organization. This process includes tracking the

claims, making sure that the payments are executed on time and dealing with

denials. The working in this cycle includes the entire process that leads to accurate

results. This considers records right from the time the patient first visited up to the

time the treatment was delivered and payment received.

Let us observe an Info Graphic that explains the step by step execution of this

process.

Appointment Scheduling

An experienced staff can be appointed to take up the responsibility of scheduling

appointments of patients. RedEngine Systems, LLC also promises to provide a toll

free number that could be used for appointment scheduling.

Patient Registration

Here, it is made sure that every detail about the patient is put into records.

RedEngine Systems, LLC, takes down all the details that may be needed at the

time of billing as well. The basic details such a history, authorization, insurance

information and verification and referrals are all added in the records.

Patient Exam

The problems and concerns of the patient are recorded. Here, the physician’s

documents are initialized.

Coding

The documentation by the physician is then referred to and converted into codes by

the medical coding professionals.

Charge Entry

The charges are later added according to the codes added by the medical coders.

Medical coders and charge entry team work together to make sure there are no

errors and that the charges match the codes that are entered.

Claim Submission

The medical claims are later transmitted using a secure or encrypted data

transmission. They are directly passed on to the carrier or the clearing house. The

clearing houses format these claims and later forward them to the carrier.

Payment Processing

Here an electronically generated bill is created. At this stage the payment, denials

and adjustments in payments are taken care of. RedEngine Systems, LLC, assure

timeliness and accurate posting of payments within the software.

Resubmission and Appeals

In case of denials, we would have to resubmit a bill that would best suit the

company clauses. There are many carriers who reject the claims or ask for some

additional information. There are many ways in which they would want to reduce

their cash outflow and thus avoid paying heed to bills when first presented. At such

times, the professionals in RedEngine Systems, LLC, work patiently and modify the

current bill and satisfying maximum carrier demands thus avoiding further denials.

Secondary Claims or Patient Billing

The medical billing professionals make sure that the payment is collected from

maximum places where the patient is insured. Thus, reducing the number of

possible denials and errors that may act as a hindrance for payment collection.

A-R Follow Up

Accounts Receivable Follow up is the process of reminding the insurance company

about the unpaid bills. RedEngine Systems, LLC, assure reducing the amount of

unpaid and partially paid claims.

Collection Agency

RedEngine Systems, LLC, work with third party Collection Agencies that help in

better payment collection.

www.redenginesystems.com

6025 Shaw Hills, CT,

Winston Salem,

NC 27107