Patient Demographics Overview

Let's review how patient demographic information is managed in the RCM.

Create a New Patient

Before entering intake or treatment information, the patient profile must exist in the RCM. Each patient profile contains a Treatment Episode. A Treatment Episode contains patient demographics and authorization information required to bill a claim. There are two types of episodes that can be created: Prospective and Admitted.

• To learn more about creating a prospective patient, click here.
• To learn more about creating an admitted patient, click here.

Set The Diagnosis

The next step is to set the patient's diagnosis. Patients without one cannot be billed until the diagnosis has been set. For more information on setting the patient's diagnosis, click here.

Manage Insurance Sets

Now that the patient's profile has been created and diagnosis set, it's time to establish their insurance set. To learn more information on creating and managing insurance sets, click here.

Create U/R Plans

After the insurance set has been configured, it's time to create the U/R plan. To learn more information about creating U/R plans, click here.

Related Claim Rules

Some payers require certain demographic information to be omitted from the claim. Refer to the list below of applicable claim rules that can assist with this.

• Add or Remove Accident Type
• Add or Remove Admitting Diagnosis
• Add or Remove Other Diagnoses
• Manage Diagnosis Present on Admission Flag
• Add or Remove Admission Date
• Add or Remove Patient Admit Hour
• Add or Remove Patient Admit Type
• Add or Remove Patient Discharge Date
• Add or Remove Patient Discharge Hour
• Add or Remove Patient Discharge Status
• Add or Remove MRN
• Add or Remove Patient Reason for Visit
• Treat Episode as Discharged