In the past, it has been commonplace for healthcare facilities to utilize medical billing services in their practices. These services provide organizations with the basic tools and services to ensure their practice is being reimbursed for the services provided to their patients. 

However, as healthcare technology has evolved and become more complex, many organizations are switching to revenue cycle management to provide their patients and providers with a more connected and complex billing platform that pulls more data than just medical payments.


What is the Difference?


Medical billing services involve the submission of claims for services that are directly delivered to individuals. Follow-ups are also done with providers, health insurance companies, and programs such as Medicaid. Because this process is so involved, it can be quite lengthy and take up to 3 months for claims to be paid. Medical billing only scratches the surface of the full financial strength of an organization.

RCM businesses take on the medical billing service while going above and beyond to determine patient eligibility for claims, documenting services, coding, and managing claims from start to finish. This is a complex financial management solution that simplifies processes for your providers, medical suppliers, facilities, and especially your patients. It also works the same way whether these claims are made through private insurance companies or government programs like Medicaid.


The Revenue Cycle Management Process


As technology has progressed, patients expect their processes to be simplified, convenient, and quick. When information is able to be obtained digitally, patients and providers are able to obtain their current status in real-time. Patients are able to see when their claims are received, payment details, and denial reasons all at the touch of a button. While medical billing is a large part of RCM, it goes further than simple billing processes.

RCM allows your business to administer various financial transactions in one place. These include:

  1. Coding
  2. Billing
  3. Compliance
  4. Collections
  5. Reports and Data Analytics
  6. Payer Contracting 
  7. Healthcare Provider Enrollment

While RCM may seem daunting, as it is very complex, it is a unique process that allows you to ensure your providers are paid so your patients can still be serviced. Each time a patient makes an appointment with the facility, the cycle begins. 

Insurance companies are contacted to ensure eligibility and the patient pre-registration begins. This is where all medical information and coverage details are obtained. This step is crucial in ensuring there are no hiccups later in the RCM and that there is a streamlined flow of funds to the organization.

This process provides efficiency to the entire organization and helps identify problems early on, such as missing data, allowing providers the ability to submit claims sooner and better understand the trends of their patients and overall organization.


Ready to Take the Next Step?


To learn more about how revenue cycle management and our team of professionals at Credence Global Solutions can transform your business, contact us today!