Why Should You Use Revenue Cycle Management for Medical Billing?

revenue cycle management for medical billing

FurthermMedical billing is one of the largest barriers to the smooth operation of healthcare organizations. Focusing on the collection, management, and money transactions, medical billing can be improved tremendously. Also, by using revenue cycle management for medical billing, you can ensure that your billings are accurate and efficient. This guide will discuss how revenue cycle management plays an important role in improving the medical billing system.

What is Revenue Cycle Management for Medical Billing?


Revenue Cycle Management (RCM) is a process of identifying, collecting, and managing revenue with accuracy. It is very important in the maintenance of healthcare practices to keep financials and transactions transparent. By using it, you will be able to focus more on the patient’s health.


If your billing practices are poor, you will face financial loss and fail to provide quality care services. Besides that, you need to adopt a valuable reimbursement system for taking care of the billing practices of a hospital. Streamline the operation of your healthcare industry with revenue cycle management to make your medical transactions viable.

Why Should You Use RCM for Medical Billing?


People often want to opt for healthcare facilities from their medical insurance. However, every insurance company has its guidelines to follow. In such a situation, there is a need to check whether this medical practice is under the policy of the insurance payer’s company.


By using RCM coding, you can easily ensure the payment collections and claim submission properly. Such advanced billing practices help eliminate the risk of claim rejection, leading to no disruption in your financial flow system. Moreover, the global pandemic situation demands the integration of medical billing coding to make your healthcare system error-free, automatic, and accurate.


How Can Revenue Cycle Management Be Successfully Connected With Medical Billing?



revenue cycle management for medical billing


The medical revenue cycle can play a successful role in healthcare practices through its main elements of data recording and information flow. As the RCM is linked with coding, all the records will be secured with easy accessibility, interpretation, and tracking facility. Moreover, in this system, healthcare providers offer the following medical information to be documented:


  • Type of disease
  • Medical equipment and procedures used previously
  • Patient history
  • Recent medication


You can reimburse medical claims with the insurance company to receive payment by submitting all the above information. In addition to that, with the integration of the RCM coding system, healthcare billing systems become successful for sole practitioners, doctors, and hospitals.


Steps of Using RCM Billing in Healthcare Centers


revenue cycle management for medical billing


The following are some basic steps of revenue cycle management that make healthcare billing practices efficient:


Patient Registration


The very first step in revenue medical practices is patient registration. To do patient check-in, information related to age, gender, phone number, address, and policy ID of insurance payer is recorded. Having all this information also saves the patient from registration every time he visits the clinic.


Verification of Insurance Plan


Another thing that you need to verify is the patient’s insurance in every appointment. It’s because the coverage status of an insurance plan can change at any time. That’s why you should double-check whether insurance can be directly claimed or not. Make sure that the insurance policy is not only active but covers the medical service you are providing.


Encounter Meeting


Encounter meeting is a discussion session between patient and healthcare service provider. In such meetings, patients explain all the medical problems and symptoms. After a detailed evaluation, the doctor decides the way of treatment. You can record this meeting as well to ensure the proper understanding. As soon as the diagnosis takes place, the claim is prepared accurately.


Medical Transcription


After the meeting, a professional will listen and record all the meetings to document complete details about patient history, diagnosis, and treatment. This step will be very helpful in patient’s future visits. Make sure to keep your transcription process accurate and error-free. Because any error in the patient history and medical records can cause problems in billing, often leading to claim rejection.


Medical Coding


You can store all the transcribed medical information and process it in the form of alphanumeric codes. While coding information, make sure it includes the reason for the patient visit, his disease, treatment, and medical service. Using RCM coding systems like HCPCS (Healthcare Common Procedure Coding System) and CPT (Current Procedural Terminology) makes it easier to access payment amounts from insurance companies.


Entry of Charge


Medical coders observe all the expenses of the healthcare providers. The charge entry is the foremost step in the preparation of the claim. After that, they submit the claim to the insurance company after filing a proper amount on it. Almost all medical claim forms contain information about patient medical history, National Provider Index (NPI) number, codes, and other services provided by healthcare.


Submission of Claim


When a claim gets ready, add information of the healthcare provider, and service is also along with patient details. Then you need to submit it to the insurance company for its reimbursements. Feel free to use advanced electronic technology to submit claims known as “Electronic Data Transfer”.


Management of Claim Denials


Make sure to submit your claim within time because insurance companies only process immediate claims. After acceptance of claims, the check-making process starts. In some cases, insurance companies pay the full amount of the claim. If your claim gets denied, you need to review and resend it to ask the company to generate total revenue.


Account Receivables


Sometimes, insurance companies deny claims even after correction. In such cases, you need to provide them more information regarding insurance coding, charge posting, and medical coding. Another thing you should do is to inquire about the reason for payment denial.


Payment Collection


When the insurance company pays all the claims, you can either get your paper check or go for an electronic fund transfer. Explanation of Benefits (EOB) is also provided along with bulk payments as a summary. In this way, you will be able to record every detail of the payment you collected.


Concluding Remarks


Healthcare billing practices can be made quick, accurate, and efficient using revenue cycle management. This medical coding system ensures the payment collection and keeps everything in the alphanumeric records for later use. Boost the revenue cycle management for medical billing  by using this encrypted billing system.

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