Billing and revenue cycle management (rcm) solutions

Billing and Revenue Cycle Management (RCM) Solutions

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• Medical billing and revenue cycle management are the lifelines of any practice. According to hbma.org, 'Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a healthcare provider or medical billing company (interaction between a health care provider and the insurance company (payer). • However, revenue cycle management is a deeper subject. As per hbma.org, 'Revenue cycle management (RCM) is the process that manages claims processing, payment, and revenue generation.

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• RCM encompasses everything from determining patient insurance eligibility and collecting co-pays to properly coding claims using CPT and ICD-10 codes. Time management and efficiency play large elements in RCM, and a physician's or hospital's choice of an EMR can be largely centered on how their RCM is implemented. • Internal factors include provider capacity/productivity, patient volume, and fees for the services rendered. External factors include insurance claims from private and government payers, payments from patients (copays, deductibles, self-pay) and other collections.

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Workflow: • Critical to communication, time, and appropriate coding, the front and back office billing functions must be interconnected leading to enhanced revenues.

Team: •

An experienced billing team is probably one of the drivers to success.

Their knowledge in latest codes and rules heavily impacts the billing process as they apply their principles and experiences to create benchmarks for practices and engineer payer regulations creating an upward increase in cash flows.

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Technology: • The revenue cycle can be optimized with the use of latest software and systems. Healthcare providers usually purchase and install revenue cycle management systems to store, manage and bill patients for services rendered

by

physicians.

Medical billing software

or

a

practice

management software are usually used for effectively tracking claims processes and revenue generation. • With revenue cycle and workflow processes in place, increasing payments and reducing bad debts is imperative to the financial success of the healthcare center.

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