Medical Billing Services vs. Revenue Cycle Management

Medical Billing Services and Revenue Cycle Management are an essential part of the healthcare industry. With the outbreak of a global pandemic healthcare institutions have faced financial turmoil. For Medical Practices to become successful and profitable it is pivotal to incorporate medical billing services and revenue cycle management software into your practice. The terms “Medical Billing” and “RCM” are alike yet different from one another. 

Difference Between Medical Billing and Revenue Cycle Management Medical Billing  

• Medical billing refers to the paperwork of filing medical claims for reimbursement.  
• Outsourcing your medical billing services provide you with a team of highly qualified staff that produce cost-effective solutions to improve your revenue generation.  
• Medical Billing has features such as Appointment and Scheduling, Analytics, and Reporting.  
• Document storage services offered 
• Electronic Claims Submission and Electronic Claims Attachments are integral part of medical billing 
• Tracking underpayment as well as denials.  
• They check eligibility verification and demographic updates  
• Claim Scrubbing is done to check for errors and verify its compatibility with the payer software.  
• They offer customizable fee schedules.  
• They also offer 24 x 7 Support.  
• Medical billing processes can be overly complex to understand at first but here are some tips to manage medical billing in your practice.  

Revenue cycle management (RCM)  

• RCM (Revenue Cycle Management) includes a variety of additional services such as reporting and analysis of the financial pipeline, patient financial services plus all the necessary tasks required to get the payment.  
• Having a dedicated RCM client services manager.  
• Services such as eligibility checking, processing of patient statements as well as denials management, appeals management 
• RCMs should have a build customized scrubber checks to meet state, specialty, and practice-specific billing guidelines.  
• Healthcare RCMs must have claim follow-up to ensure payer acceptance.  
• A designated call center to take patient calls.  
• Posted updates on insurance payments, patient payments, and denials.  
• RCM thus shortens your revenue cycle whilst optimizing patient care and managing your finances.  

Why is revenue cycle management more than medical billing?

Revenue Cycle Management (RCM) is the process of managing and controlling the financials of a practice through a revenue cycle or medical billing software. The process begins right from the initial stage of patient registration to billing, claims management, to finally the payment of the balance. 

Managing the revenue cycle is a difficult undertaking. It deals with more information and processes than what billing services deal with.  

They include transactions such as:    

• Billing  
• Coding  
• Collections  
• Compliance  
• Data Analytics  
• Management Duties  
• Payer Contracting  
• Provider Enrolment

The RCM process begins when a patient makes an appointment. RCM takes patient data from your electronic health records software ensuring claims are not lacking any information. Thus, RCM helps to improve workforce efficiency.  

RCM services provided by PrognoCIS will help you simplify your business by streamlining your practice’s account management from the initial through payment. They offer:  

• A team of dedicated experts including a client manager, an account manager, an A/R manager, and a credentialing professional, upon request.  
• They integrate their EHR system with Practice Management software, hence, billing, and electronic medical records are managed in a single solution.  
• They partner with Tier 1 clearinghouses like TriZetto Provider Solutions.  
• On completion of medical coding, medical billers process claims that are stored electronically or on paper. In cases of claim denial, the team conducts denied claims management.  
• The RCM team follows up on all unpaid claims after 25 days.  
• RCM identifies problems such as missing patient data so you can rectify them immediately and submit them to receive payment sooner.  
• Eligibility verifications are done prior to patient appointment.  
• Subscribe to PrognoCIS RCM services and stay updated by signing up for our newsletter.  

Key Takeaway  

Revenue Cycle Management can be a challenging and sometimes a tedious process, but it eventually generates greater ROI for the practice. Medical practices need to be on top of the game when it comes to managing their revenues. The most important step in managing the revenue cycle successfully is continuing to automate the administrative, clinical and the billing process.