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MEDICAL BILLING RCM CYCLE WORKFLOW

Step-by-Step Detailed Process

Patient Scheduling
& Registration
Insurance Verification
& Eligibility Check
Insurance/Service
Eligibility Check
Obtain Prior
Authorization
Medical Coding
(ICD-10, CPT, HCPCS)

Claim Scrubbing / Edits


Encounter/Service
(CD-10, CPT, HCPCS)
Claims Scrubber/Edits
Charge Entry
Claim Submission
(EDI/Paper)

Payer Adjudication

Account Settlement

Payment Posting
& Reconciliation
Denial Management
& Appeals
Denial Management
Appeals

Account Settlement

Settling

Patient Billing

Patient Billing
Collections & Appeals
Collections & Appeals
ANALYTICS & REPORTING
• RCM Performance KPIS
• Denial Trends
• Financial Reports
• Payer Mix Analysis

Prior Authorization Requirement


flowchart

by gaana

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