Careeo involves various steps to ensure accurate and timely reimbursement for healthcare services.
Here are the key phases:
1. Patient Pre-Registration:Collecting patient information, insurance details, and demographics before the appointment.
2. Appointment Scheduling:Efficient scheduling of patient appointments,considering both medical needs & financial aspects.
3. Eligibility Verification & Pre-Authorization: Confirming the patient’s insurance coverage, checking benefits and eligibility for services, and applying pre-authorization
4. Charge Capture:Accurately recording the services provided during a patient visit for billing purposes.
5. Medical Coding:Assigning standardized codes to diagnoses and procedures for billing accuracy.
6. Claim Submission:Creating and submitting claims to insurance companies for reimbursement.
7. Claim Rejection:Identifying the reasons behind claim rejections by thoroughly analyzing the rejection codes and explanations provided by the insurance company.Addressing any errors or discrepancies in the rejected claims, such as coding errors, missing information, or inaccuracies in patient details.
8. Payment Posting:Recording and reconciling payments received from insurance companies and patients.
9. Denial Management:Identifying and addressing claim denials to ensure proper reimbursement.
10.Patient Billing and Collections:Managing patient billing, sending statements, and collecting payments.
11. Financial Reporting:Generating reports to analyze the financial performance of the healthcare facility.
12. Follow-Up and Appeals:Following up on unpaid claims, appealing denials, and addressing any outstanding issues.
13. Provider Credentialing:Enrolling the provider with various insurance plans by completing the necessary paperwork and meeting the requirements of each insurance company.
Efficient Revenue Cycle Management is crucial for the financial health of healthcare organizations. It involves coordination between various departments, adherence to regulations, and the use of technology to streamline processes and reduce errors. A well-managed revenue cycle helps optimize revenue, improve cash flow, and enhance overall financial performance.