The COVID-19 pandemic plunged the world and healthcare organizations into an unprecedented commotion of financial unpredictability that several are struggling to get out of even now. However, the pandemic left behind a trail of lessons, one of which was the unflinching attention required to the financial strength of an organization by revenue cycle management .
Medical billing has proved its significance over time, but it is not as accurate an indicator of the overall financial health of an organization as we would like to believe. The key to determining an organization’s financial success lies in managing and evaluating the entire revenue stream instead of merely its billing components.
The Difference between Medical Billing Services and Revenue Cycle Management
Determining revenue cycle management is unequivocally the key to success when managing a healthcare organization. Revenue Cycle Management solutions include billing components that transcend beyond their payment posting scope. Several medical professionals use Healthcare Revenue Cycle Management solutions to track, assess, and thus effectively manage the patient claims status on their account receivables.
According to the Healthcare Business Management Association, medical billing services are related to submitting medical claims for services provided to patients. They then follow up with health insurance services to cover these claims. This revenue cycle process is quite similar for various governmental programs, including Medicaid, and private insurance companies as well.
Revenue cycle management generally covers more data, information, and processes than those dealt with in medical billing services. Such medical encounters occur between patients and facilities, healthcare providers, or medical suppliers. The transactions may include coding, billing, data analytics, payer contracting, compliance, collections, management duties, and healthcare provider enrollment.
Revenue Cycle Management
Revenue cycle management is a complicated endeavor. However, its intricacies indicate that it needs to be since it is imperative to keep paying your staff as your first priority. If not, you will be unable to offer your patients medical services. Therefore, revenue cycle management involves a nexus of interconnected processes.
Compared to generating medical bills and redirecting them for approval along with both patient payments and insurance reimbursements, the revenue cycle management process begins considerably earlier. Revenue cycle management responsibilities begin as soon as a patient contacts your medical staff for an appointment or books one online.
That is effective and prudent, as a friendly reminder from your medical staff about payment for a medical visit being due that day, or even hanging a simple sign on your reception area’s most in-view wall, can help considerably in diminishing delays and losses in reimbursement and payment. Thus, revenue cycle management works by amalgamating all the financial details necessary for the provision of medical services and receiving refunds on time in one place.
Optimize revenue cycle management
It is general practice to optimize revenue cycle management with intricate pre-registration processes as a medical practice also develops a new patient account or portal. Once that is out of the way, all that is left to do is punch in the patient’s medical history, personal information, and information about insurance reimbursements and medical coverage.
A medical practice that fails to identify a patient’s medical reimbursement coverage is likely to suffer from consequences later. For instance, your medical staff detects that a particular insurance provider does not cover a certain medical procedure. In that case, a seamlessly working RCM setup will extend support in avoiding such road bumps while streamlining revenue flow in your firm.
Revenue cycle management transcends the shackles of mere billing processes, even if billing is one of its prime components. A robust revenue cycle management process is bound to augment the efficiency of an organization and portend an innovative level of insight and transparency never witnessed before. It is also highly helpful in rooting out problems like missing data, so their correction is prompt and without consequences.
As you can see, Revenue Cycle Management is a complex endeavor. It needs to be. Keeping the lights on and making sure you can pay your staff is your first priority. Otherwise, you can’t offer service to patients.
RCM needs to involve many interconnected processes. Revenue cycle Intelligence explains that contrasted with the act of generating bills and sending them for approval and both insurance and patient payments, revenue cycle management begins earlier in the process.
Deeper Into the Revenue Cycle Management
Much back-end office work goes on after you submit claims. Managing the revenue cycle includes processing patient statements and working with collections. Consider claims that have a problem, such as an employee entering an incorrect code. The faster you can identify mistakes, the sooner you can send in a proper claim.
What do your monthly reports tell you now about. How long it takes on average for insurers to reimburse for claims. A strong RCM system will make your organization work efficiently.
What do your monthly reports tell you now about. How long it takes on average for insurers to reimburse for claims. A strong RCM system will make your organization work efficiently.
You’ll benefit from tools as:
- Daily cash flow reports
- Weekly reports on collections
- Monthly reports to keep tabs on your practice’s financial health
The RCM takes patient data from your electronic health records software. This ensures that claims aren’t going out with missing information. Lack of information results in wasting time with back-and-forth efforts between your office and the insurance company.
Advanced revenue cycle management is more powerful when it uses features from emerging software innovations.
CPT AND HCPCS PROCEDURE CODES
Procedure codes complement diagnosis codes by indicating what providers did during an encounter. Current Procedural Terminology (CPT) codes and the Healthcare Common Procedure Coding System (HCPCS) make up the procedure coding system.
The American Medical Association (AMA) maintains the CPT coding system, which describes the services rendered to a patient during an encounter for private payers. AMA publishes CPT coding guidelines each year to support medical coders with coding-specific procedures and services.
The American Medical Association (AMA) maintains the CPT coding system, which describes the services rendered to a patient during an encounter for private payers. AMA publishes CPT coding guidelines each year to support medical coders with coding-specific procedures and services.
CPT codes have modifiers that describe the services in greater specificity. CPT modifiers indicate if providers performed multiple procedures, the reason for a service, and where on the patient the procedure occurred. Using CPT modifiers helps ensure providers receive accurate reimbursement for all services.
10 steps in Medical Billing
The ten steps in the process of Medical billing are as follows:
- Patient registration
- Insurance verification
- Encounter
- Medical transcription
- Medical coding
- Charge entry
- Charge transmission
- AR calling
- Denial management
- Payment posting.
Medical Billing Management Services
To make the entire billing process smoother, you can opt for more than simply outsourcing collections. By hiring a medical billing service provider, you can also analyze, manage, and organize your claims, thus streamlining your business’s billing process and reducing the risk of mistakes while billing.
People know all the different insurance companies, regulations, laws, medical codes, and recent changes. They can dispute rejected claims with relative ease due to their expansive knowledge of clauses and codes.
SmartClinix can help put your worries aside by providing a dedicated billing team with trained professionals equipped with the latest information and technology to approach your medical billing. So, feel free to head over to SmartClinix right now, and let your worries about medical billing end!
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