Medycoding

Patient Registration Process in the Revenue Cycle

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Basic Knowledge and role

Patient Registration is the first and foundational step in the Revenue Cycle Management (RCM) process in healthcare. It refers to the collection and verification of key patient information before any medical service is provided. This step ensures accurate billing, eligibility verification, and claim submission later in the cycle.

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Purpose of Patient Registration in RCM:

To establish the patient’s identity and insurance details so that:

• Healthcare services can be billed correctly.

• Insurance eligibility can be verified.

• Claims can be submitted without error or denial.

• Payment can be collected smoothly from the payer or patient.

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Key Activities in Patient Registration:

StepTask

1️⃣Collect demographic details: Full name, DOB, gender, address, phone, email.

2️⃣Capture insurance information: Payer name, policy number, group number, coverage period.

3️⃣Verify insurance eligibility: Confirm if coverage is active and services are covered.

4️⃣Check for prior authorizations if required by the insurance for specific procedures.

5️⃣Assign a patient ID / MRN (Medical Record Number) for identification in the system.

6️⃣Collect copays (if applicable) at time of visit or admission.

7️⃣Consent forms & signatures: Patient signs privacy notices, treatment consent, etc.

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What is consent and Authorization?

Patient registration may involve obtaining the patient’s consent and authorization for the collection and use of their health information in accordance with privacy laws and regulations. This includes explaining the facility’s privacy practices, patient rights, and consent for treatment and sharing of information with relevant parties.

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What is financial responsibility ?

During registration, patients may be asked to provide information related to their financial responsibility, such as co-pays, deductibles, or any self-pay arrangements. This allows healthcare providers to estimate the patient’s financial obligations and ensure accurate billing and payment processing.

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What are the important of medical history and allergies in registration ?

Medical History and Allergies: Patient registration collects important medical history and allergy information. This information is crucial for healthcare providers to provide appropriate and safe care to patients. It helps them understand any pre-existing conditions, allergies, or medications that may impact the patient's treatment plan.

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What are the difference between patient registration and check in ?

Patient registration and patient check-in are key steps in the healthcare Revenue Cycle Management (RCM) process. Registration happens before the appointment and involves collecting important patient details like name, contact info, insurance details, and assigning a medical record number (MRN). Its main purpose is to create or update the patient's profile for accurate billing and care. On the other hand, patient check-in occurs on the day of the appointment and confirms the patient’s arrival. It includes verifying identity, updating any information, collecting co-pays, and signing consent forms. While registration builds the record, check-in ensures it's correct and ready for the visit.

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Insurance and Eligibility

 

How do you verify a patient's insurance eligibility and benefits?
Using online insurance portals, payer websites, real-time eligibility (RTE) tools, or by calling insurance companies directly.

What steps do you take if a patient’s insurance is not active on the day of service?
Inform the patient immediately, ask for alternate insurance or payment method, and reschedule non-emergency services if needed.

Have you worked with prior authorizations or referrals?
Yes. If a service requires prior authorization or referral, I coordinate with the referring physician or insurance company to obtain it before the patient’s visit.

 

 

Compliance and patient communication 

How do you ensure HIPAA compliance during the registration process?
I maintain patient confidentiality, never disclose details in public areas, and ensure that all information is stored securely in the system.

How do you handle situations where a patient refuses to provide certain information?
I explain why the information is important for insurance, billing, and care. If they still refuse, I escalate the matter to a supervisor or document the refusal as per policy.

Can you explain what an ABN (Advance Beneficiary Notice) is and when it is used?
An ABN is used when Medicare may not cover a service. We inform the patient beforehand and have them sign the ABN to acknowledge responsibility for payment if the claim is denied.

 

 

Scenario based question

A patient’s name in the insurance database is different from your records. How would you handle it?
I verify their legal name on ID and insurance card, confirm with the payer, and update our system accordingly. We always go with the name as it appears on the insurance record.

A patient arrives without a referral for a service that requires it. How do you proceed?
I inform the patient, contact the referring doctor, and try to obtain it on the spot. If unavailable, I explain to the patient the implications and may reschedule.

 

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What are the eligibiligy of medicare insurance in US healthcare ?

Eligibility Criteria for Medicare:

1. Age-Based Eligibility (Most Common):

   • 65 years or older

   • Must be a U.S. citizen or legal permanent resident (living in the U.S. for at least 5 continuous years)

2. Disability-Based Eligibility:

   • Under 65 years with a qualifying disability

   • Must receive Social Security Disability Insurance (SSDI) for 24 months (2 years)

   • Automatic enrollment in Medicare begins in the 25th month

3. Specific Disease-Based Eligibility:

   • Any age if diagnosed with:

     • End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or transplant)

     • Amyotrophic Lateral Sclerosis (ALS) (Lou Gehrig’s disease) – Eligible immediately upon starting SSDI

What is MRN?

MRN stands for Medical Record Number.

MRN is a unique identification number assigned to a patient by a healthcare facility (hospital, clinic, etc.) when they first register.

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What is EHR ?

Electronic health record is the medical record in the electronic form.

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What is Tricare insurance?

TRICARE is a healthcare program of the United States Department of Defense (DoD) that provides medical insurance for military personnel, veterans, and their families.