Function 04: Billing and RCM

Billing and revenue cycle is the path from a completed chart to a submitted claim. We enter charges from the finished file, submit to payers, read denials, correct and resubmit, and send patient statements on the rule you set. Coding follows what the note supports. We do not invent a code the clinician did not document.

The work

- Enter charges from a complete chart
- Submit claims to payers
- Read denials and resubmit corrected claims
- Send patient statements on the practice’s rule
- Keep a worklist so open claims are not silent

What we do

- Charge entry tied to a complete patient file
- Denial review and resubmission
- A weekly claim worklist

What we do not do

- Writing off balances without the owner’s rule
- Adding codes the note does not support
- Replacing the practice’s accountant or tax filing

Outcomes

- Charges go out from complete files
- Denials have a next action
- The owner is not the only person who knows what was billed

Done looks like:

Claims are submitted, denials are worked, and statements follow the practice rule.

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