Medical billing is only part of the Revenue Cycle Management

Claim submission and follow up 

A major part of accurate billing is submitting accurate claims to both commercial and governmental insurance providers. Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for service rendered. Without submitting claims on time, it doesn’t matter how many patients you see or how many devices you render. 

Medical billing is only part of the financial management process that we refer to as revenue cycle management (RCM). Components of a medical billing process are as follows, 

  • Patient check-in 
  • Insurance Eligibility and verification
  • Charge entry
  • Coding – Diagnosis, Procedures, and Modifiers 
  • Claims Submission 
  • Payment Posting 

Managing all the Information  

  • Claim preparation – Preregistration and registration capture the billing information and this is the time to communicate coverage of services and payment expectations.  
  • Coding and charge capture are the key components for efficiently processing claims. 
  • Claim submission – This is only as good as the information on the claims and processed as directed by insurances through a clearinghouse. 
  • Claims Management – Remittance processing can easily be accepted and applied to patient accounts or rejected for further payment consideration. Patient collections can easily and quickly be managed. Third-party follow up can be integrated using today’s RCM. 
  • Report Analysis – Utilisation review can prove beneficial to discovering practice deficiencies. 

Analyze to capture payments 

An effective RCM system can reduce the amount of time between providing a service and receiving payment by interacting with other health IT systems. We know that the information going into your system is vital to the medical billing process but knowing everything about your accounts receivable is the final part of managing the revenue cycle. Timely, accurate financial reports can be invaluable tools for assessing your practice in financial health. Few points to do this effectively are listed for better understanding. 

  • Train staff to collect patient responsibility at the time of service when it’s least costly to collect.  
  • Follow write-offs to catch those payers that are exceeding a predetermined percentage of charges.  
  • Weekly reports and monthly reports will be useful for practicing overall financial health. 

Affected by key processes 

For accounts receivable to be successful, it is vital that every department works towards making sure the healthcare facility can collect for its services.  

  • Legal concepts involve educating and training staff to ensure invoices accurately go out without fraudulent information 
  • Compliance manual is a necessary tool to include both ethical and legal concepts 
  • Patient rights are important to enhance patient experiences
  • Charge capture is critical for services rendered 
  • Patient financial services are ultimately responsible for the accurate and timely billing and collection of accounts receivables in the medical office. 


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