Question

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Answer 1

The diagnosis and procedures of medical examination should correctly match with the medical claims. The claims should follow all the regulations. However, the claims can be rejected on the ground of medical necessity errors and coding errors. Compliant billing refers to the correct claims report and there should be proper link between billed service and the diagnosis.

Seven steps of revenue cycle:

The seven steps of revenue cycle are as follows:

Step 1:

Pre-registration:

The revenue cycle starts with the pre-registration of the patients of private health plan. The basic demographic and insurance information is collected from the patient.

Step 2:

Verification of insurance eligibility:

Verification of insurance eligibility involves verifying the eligibility of the person to be insured for a plan.

Step 3:

Collection of co-payments:

The third step of the revenue cycle is the collection of co-payments.

Step 4:

Checking of code:

The code number is verified with the help of coding compliances and standards.

Step 5:

Check billing compliance:

The fifth step of the revenue cycle follows the detailed checking of bill for requisite compliances.

Step 6:

Collection of other payments:

All the payments are collected. The payment can include deductibles, charges, and other non recovered services.

Step 7:

Transmission of claim:

The last step of the revenue cycle is the transmission of claim according to the payer’s bill.