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Patient registration is the most crucial step in the registration cycle for billing specialists. Patient registration enables billing specialist to collect demographic, insurance, and eligibility data in real-time. Additionally, financial obligations of patients, such as payment plans and termination regulations, are highlighted (Jain & Panchal, 2019). Another critical step is the submission of a claim. Following charges entry, claim submission entails communicating with the insurance provider. During this step, billing specialists will review the charges, current procedural terminology, and diagnostic codes. To ensure revenue cycle flow, billing experts will inquire whether the diagnosis supports the proposed procedure.
Billing consultants are responsible for several factors that may result in insurance denials, including duplicate billing and upcoding or unbundling. These errors frequently occur due to billing specialists blunders. Human error is the most common cause of a double bill. For instance, if a client resends a request without deleting the prior one from their record, their account may be affected (Jain & Panchal, 2019). Unbundling is a billing practice in which billing professionals create a separate bill for each procedure or test performed, resulting in totals above the specific reimbursement rates. This is prohibited and results in insurance claims being denied.
Consequences of Improper Following of Revenue Cycle Processes
If the patient does not adhere to the cycles process, the insurance company may deny the claim or delay the reimbursement process. All pertinent information is required before reimbursement is issued to the correct patient. If a provider violates any of the procedures, reimbursement issues may develop. Many healthcare organizations face financial insolvency as a result of insurance refusal. Any mistakes that occur during the revenue cycle process can have a substantial impact on the cash flow of health care companies (Jain & Panchal, 2019). Insufficient cash flow will result in poor administration of health care institutions, and the quality of patient care may deteriorate significantly. This is due to a lack of sufficient funds from reimbursement funds to support the organizations operations. As a result of insurance denials, patient services will not be appropriately billed. Revenue cycle management must be performed correctly and painstakingly for ones business to be profitable and cash-rich, regardless of the size of the facility or the number of sites within the health care system.
Reference
Jain, V., & Panchal, G. (2019). Pricing and revenue management in fragmented and segmented supply chains. Journal of Revenue and Pricing Management, 18(5), 353-354. Web.
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