Medical Billing Explained: How Revenue Cycle Management Can Improve Your Business

Written by teamlogik
13 Oct, 2020

One of the most important parts of any medical practice is billing, which can be both overwhelming and time-consuming for staff. Moreover, errors in billing can be costly – but there is a solution: Revenue Cycle Management (RCM). RCM is a complete billing service performed by dedicated denial management experts that can handle specific needs for your healthcare practice so you can focus on what’s important – patient care.  

Revenue Cycle Management 

Revenue cycle management refers to the need to identify, collect, and management payments based on the services provided. The revenue cycle itself must be understood thoroughly to understand the importance of RCM processes. 

The starting point of the cycle is when the patient makes the appointment, and the end of the cycle is when payment is collected. The in-between stages are where inaccuracies can arise that lead to missed payments. These include missing/incorrect information, improper coding, and canceled appointments, to name a few. An effective RCM billing service can help avoid problems and ensure you get paid on time. 

The revenue cycle process within healthcare is highly complex and is overseen by regulatory agencies. RCM can be done by experts whose sole function of managing your billing and revenue. This is especially important as medical billing has become increasingly complicated, particularly with the switch from ICD-9 to ICD-10. RCM services ensure that there are fewer billing errors, which means that insurance company reimbursements are maximized.  

Revenue cycle management teams can be a critical part in managing the maintenance of compliance and coding regulations, such as the required update to ICD-10 from ICD-9. Using the correct coding (ICD-10) for services rendered ensures that insurance claims are processed, and providers can collect on all services rendered.  

Common Errors within the Revenue Cycle 

The first part of the revenue cycle is registration. In this phase, it is the responsibility of the provider to get all the information needed from the patient to bill the appropriate insurance company. Typically, this involves personal information (name, birth date, address, phone number, gender, social security number, and emergency contact) and insurance provider information. Clerical errors made during this stage, such as incorrect personal information or failure to validate insurance coverage, are some of the biggest problems that lead to denials from insurance payers. Typically, it’s easy to identify and fix these errors through amending the information and submitting a new bill. However, it is critical to monitor denials daily to see the denial ratio generated from clerical errors so that the medical practice can appropriately address any problems. 

Complying with Medical Coding Regulations 

Having optimal coding compliance means that revenues are higher and claim denials are decreased. Optimal coding helps the medical practice to prevent disruption caused by regulatory penalties and impacting the medical flow. The billing/collections team is responsible for the submission of a complete UB-04 claim or CMS1500 form to the insurance company after services have been received on either an inpatient or outpatient basis. A third-party claim scrubbing system is used to ensure that claims are complete and clean, including those edits that may update the claim data received. Scrubbing the claim is important, as it may help avoid a potential denial from the insurance payer, which delays reimbursement to the provider. Denials can be returned as a response to the claim with a specific reason. With RCM services, a denial management expert can help: 

  • Process immediate claim resolutions  
  • Identify any trending issues, and  
  • What part of the workflow — clinical or clerical — it involves 
Benefits of Revenue Cycle Management 

Revenue cycle management for healthcare practices can be beneficial for numerous reasons:  

Time Management 

When you engage in revenue cycle management, the responsibility of processing insurance claims is given to specialists, meaning more of your time can be dedicated to caring for patients.  

Organization 

Having a complete billing solution that is all-inclusive gives you a better opportunity to be organized, as compared to trying to integrate all needed information into potentially outdated software. Reporting and documents work in collaboration with RCM to provide a complete record of the patient, meaning important data is readily available, organized, and easy to view to all who need it – making easier to avoid delayed payments. 

Financial Viability 

There are ongoing expenses in any healthcare practice that can extend from payroll to maintenance. The use of RCM services can help maintain a steady stream of revenue to ensure that operating expenses are covered. 

Customized Plan 

Like patient treatment plans, a single or one-size-fits-all approach, simply will not provide the best outcomes. RCM approaches can be designed for individual healthcare practices to improve collections.  

Insurance Claim Management  

As discussed earlier in this blog, dealing with insurance claims can be complicated – especially when each patient has a different list of services that must be invoiced. An effective, complete billing solution can help determine if visits are billable or nonbillable, as well as assist in developing plans to get you paid. 

Logik Solutions & RCM  

RCM can be a turning point in the success of your healthcare practice. Logik Solutions, a complete billing solution for healthcare providers, offers RCM services to help save you time, and minimize overhead for your billing staff.  Read more about RCM, or speak to a specialist to get started today! 

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Team Logik

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