Patients’ clinical documentation should be complete and according to the requirements of CMS guidelines. Assimilate the documentation process into daily decision making to ensure that the patient record is complete and compliant with ICD-10 coding standards.

This is the most critical phase of the RCM workflow. Based on the information in the Superbill, the physician will be paid for the services provided. The Superbill should contain the diagnosis and procedures performed on the patient, along with correct CPT and ICD codes.

Collecting copays at the time of registration is usually the best front office practice. However, in case of patient emergency or peak hour rush, patients can be asked to pay before they leave the practice.

Physicians should have EHR and Practice Management system that would enable them to code with ICD-10. Due to the complex nature of the codes, practices should hire professional coders to ensure claim processing on the first submission.

In this day and age, claim denial is a serious concern that providers have to face. Delayed reimbursements due to claim denials weigh heavily on the revenue stream of the practice. To avoid the delay, it is imperative that the providers, front desk, coders and billers, and clinical staff should provide accurate details, which are required to be mentioned in the claim.

The RCM completes when the providers receive payment for their services. In case of denied claims, the provider will be informed through ERAs. Then begins the cycle of claims processing, consuming your time and resources.