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Revenue Cycle Management

Medical Billing Vs. Revenue Cycle Management?

We’ve all been through a lot of financial uncertainty as a result of the COVID-19 pandemic’s early stages. Healthcare organizations have seen their fair share of financial difficulties. Large and small practices are currently attempting to re-establish themselves.

Patients were remaining at home in large numbers. They were apprehensive about venturing out into the masses. People were concerned about unventilated locations where the infection could remain longer. As a result, patients postponed routine examinations and tests. Some people were skipping critical operations that had previously been scheduled for a long time.

You might still be sifting through the financial consequences. It’s more crucial than ever to pay close attention to your organization’s financial health.

Medical Billing Services vs Revenue Cycle Management: What’s the Difference?

Revenue cycle management is critical to the success of any healthcare organization. Billing is a component of Revenue Cycle Management solutions. However, Revenue Cycle Management encompasses more than just payment posting. Medical practitioners utilize Healthcare Revenue Cycle Management software to assess, track, and effectively manage patient claims on their accounts receivables.

Medical billing services, as defined by the Healthcare Business Management Association, involve submitting claims for services delivered to patients. Then they take care of following up with the health insurance companies on these claims. For government programmers like Medicaid and private insurance businesses, the revenue cycle mechanism is the same.

Revenue Cycle Management entails a greater amount of data and processes than what we deal with in billing services. RCM is concerned with the management of a variety of financial transactions that arise as a result of medical encounters. Patients come into contact with medical supplies, institutions, or healthcare practitioners.

The following are examples of transactions:

  • Billing
  • Coding
  • Collections
  • Compliance
  • Analytical Data
  • Management responsibilities
  • Contracting with the Payer
  • Enrollment of Providers

Revenue Cycle Management, as you can see, is a difficult task. It has to be done. Your first responsibility is to keep the lights on and ensure that you can pay your employees. You won’t be able to provide service to patients if this isn’t the case.

Revenue cycle management necessitates the involvement of numerous interrelated processes. Revenue cycle management, according to Revenue cycle Intelligence, begins earlier in the process than the act of producing bills and sending them for approval, as well as both insurance and patient payments.

When a patient arranges an appointment with your staff, your RCM tasks begin. A member of your team will need to call the insurance company to confirm the patient’s eligibility and status. At this point, your staff will go over the patient’s bill-paying responsibilities.

That’s sensible, because a notice in your reception area and a reminder from your staff that payment for an office visit is due that day will help you avoid refund losses and delays. RCM software is great for putting all of the financial aspects that go into providing services and getting paid on time together.

Since you’re creating a new patient account, you optimize the RCM with pre-registration steps. It’s then simply an issue of entering his or her medical history and coverage information.

Failure to check a patient’s insurance coverage could lead to complications later. For instance, suppose you discover that a procedure is not covered by your insurance. Such issues can be avoided with a strong RCM system. Simultaneously, it improves the flow of funds within your company.

Getting a Better Understanding of Revenue Cycle Management

After you submit claims, there is a lot of back-end office work to be done. Processing patient statements and engaging with collections are all part of managing the revenue cycle. Consider claims that have an issue, for as when an employee enters the wrong code. The sooner you can spot errors, the sooner you may file a proper claim.

What do your monthly reports say currently about how long it takes insurers to refund claims on average? Your organization will run more smoothly if you have a solid RCM system in place.

You’ll gain access to tools such as:

  • Daily financial flow reports
  • Collections reports are sent out every week.
  • Keep track of your practice’s financial health with monthly reports.

Your electronic health records software feeds the RCM with patient information. This guarantees that claims aren’t sent out with information that isn’t complete. Due to a lack of information, time is wasted with back-and-forth communications between your office and the insurance provider.

When advanced revenue cycle management incorporates elements from new software developments, it becomes even more powerful.

Are you ready to implement revenue cycle management software in your company?

Effective billing services, particularly in the context of revenue cycle management, is a difficult topic, and it’s likely that you and your colleagues will be looking for some advanced information. This allows you to take advantage of the full potential of RCM tools.

Medics RCM, for example, incorporates artificial intelligence to assist practises in scaling up quickly as they expand while also providing complete, end-to-end revenue cycle management services.

Medical billing is only one aspect of a comprehensive revenue cycle management system. Medical billing software should integrate patient charge information into the revenue cycle stream and assign values to relevant databases. Before dropping the claim, a record and verification section in the medical billing software should ensure the existence of required evidence. After the claim is dropped, another element should verify that it was transported and received by the electronics claim clearing house.

Revenue cycle management software, on the other hand, makes it possible to manage income effectively by automating, simplifying, and organizing operations, as well as finding revenue leakage. The software also provides a variety of analytical reports, keeps track of revenue flows, denials, and collections, and handles them.

There are many opportunities to drastically improve your revenue cycle management. These improvements may seem to be on the pricey side and time consuming.

Practolytics is a 20+ year old healthcare technology and management company. We partner with healthcare practices to provide end-to- end solutions including medical billing, healthcare consulting and practice analytics, allowing practices to eliminate revenue cycle management inefficiencies. Our diverse background in every aspect of healthcare allows us to maximize revenue and consistently deliver optimum results.