Yes, Medical Coding is comes under Revenue Cycle Management (RCM). Medical Billing and Medical Coding are two main part of RCM process.
What is RCM Process in US Healthcare?
Revenue cycle management (RCM) is process of managing the financial transactions that occur in a healthcare facility, from the initial patient registration to the final payment for services rendered. There are 8 steps in complete RCM process and it start when patient comes in facility, all steps are mentioned as below,
1. Collect Patient Demographics
- Name
- Date of Birth
- Gender
- Pat. Address
- Phone Number
- Emergency Contact Information
- Social Security Number (SSN)
2. Verify Insurance Information
- Insurance Provider
- Insurance Policy Number
- Group Number
- Plan Type: (e.g., PPO, HMO, Medicaid, Medicare).
- Coverage Details
- Primary & Secondary Insurance information
- Subscriber Information: If the patient is a dependent on someone else’s plan.
3. Confirm Insurance Eligibility
- Verify Coverage
- Check for Eligibility Issues: Verify if the patient’s insurance will cover the specific treatment or service.
4. Obtain Consent and Acknowledgment
- Consent to Treat: The patient must agree to receive medical services.
- Financial Responsibility: The patient agreed that they are responsible for any charges not covered by insurance (As, co-pays, deductibles, or non-covered services).
- HIPAA Compliance: The patient acknowledges receipt of the healthcare provider’s Notice of Privacy Practices under HIPAA regulations.
- Assignment of Benefits: The patient agrees to assign their insurance benefits directly to the healthcare provider.
5. Document Referral Information
- Referring Physician information
- Referral Authorization: If authorization required for treatment.
6. Financial Responsibility Acknowledgment
- Co-pays and Deductibles: Confirm the patient’s co-pay amount and discuss any out-of-pocket expenses they might need to pay at the time of service.
- Payment Plan Options: If applicable, offer or discuss payment plan options for any balances the patient may owe.
7. Enter Data into the System
- All information is entered into the healthcare provider’s Electronic Health Record (EHR) /Practice Management System.
8. Issue Patient ID/Account Number
- After completing registration, the patient is assigned an account number, which is used to track the patient’s visits, treatments, and billing information and records.
What is Medical Coding?
Medical Coding is a process in which all medical treatment, diagnosis, procedures and services converted into standard codes which are created and governed by AMA – American Medical Association and CMS- Center for Medicare and Medicaid Services.