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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
Prior Authorization Required?
Obtain Prior Authorization
Medical Coding (ICD-10, CPT, HCPCS)
Charge Entry
Insurance Verification
Encounter/Service (CD-10, CPT, HCPCS)
Claims Scrubber/Edits
Claim Denied/ Underpaid?
Payer Adjudication
Account Settlement
Claim Submission (EDI/Paper)
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
Legend:


Patient Vhel Code

Denirintung Ched Eitt lats Fneds

Repontg bdoh & Analytics

flowchart

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