Difference Between Medical Billing and Revenue Cycle Management

In-house Medical Billing

Initially, physician’s offices had a person in-house that handled everything having to do with billing for the practice. This person added to the overhead of the office – about 10 – 12% and handled everything from A-Z in the billing process. General knowledge of codes was all that was needed to ensure reimbursement from insurance companies as this was before managed care.

The beginning of managed care brought to the industry fee schedules, preferred provider contracts, the need for pre-authorizations, and more. These changes meant a more intensive knowledge of medical codes was required as well as continuing to keep updated as codes were added and deleted.  These changes increased the cost and time required to handle billing.

Outsourced to Medical Billing Companies

A couple of decades ago, medical billing companies came onto the scene. Someone realized they could do all of the medical billing for multiple doctors saving the doctors time and money.  This service included submitting claims, working with denials, and getting doctors paid by the insurance companies.

One of the biggest issues came in because now the doctor had to deal with more than one person. There was the office manager, consultant, credentialing, and finance/business development – all separate but necessary parts of the whole process. Along with that were some stumbling blocks – there was no verification, documents had to be scanned and provided to the medical billing company and these companies didn’t work within the doctor’s internal system. The cost was around 8 – 10%.

Revenue Cycle Management for Healthcare

After listening to what clients were asking for, a more robust system was created that covered more than just standard medical billing. This full-cycle revenue management system saved doctors time and money by eliminating the need to have different people handling all other aspects. Revenue Cycle Management includes:

• Insurance Eligibility – insurance verification and patient eligibility details checked two days ahead of a patient’s appointment ensuring 100% upfront collection.
• Charge Posting – ensuring demographic information is entered in the system accurately helping to eliminate rejections or denial from the payer which can prolong the reimbursement turnaround time
• Documentation Review – once visit notes are locked coding team retrieves a random sampling of the weekly visits to review and ensure proper guidelines were followed. We also provide education to the doctor and staff on their usage of CPT/ICD -10 to help them improve on future documentation.
• Claim Submission – claims are reviewed and scrubbed to ensure that all information in the claim is correct to help eliminate a denial.
• Denial Management – when payment for services is denied, we follow up with the insurance carrier to determine if it is a coding error or something else that has facilitated the denial. We complete appeals and add any supporting documentation submitted through your software.
• Payment Posting – critical to the health of your AR – insurance payments posted to patient accounts from EOB’s in the doctor’s system with a turnaround time of 24 to 48 hours. With daily payments accessible via the practice management system.
• Account Receivables – a team assesses AR, runs any reports necessary to determine those claims that have outstanding action, and organize them accordingly. Providing follow-up notes on claims within the software for full transparency.
• Patient Collections – we send out monthly statements for outstanding balances and actual take calls from patients with questions on their bills.
• Authorizations ­– we can handle obtaining pre-authorizations in a variety of formats including online forms, faxing request forms from the client’s Practice Management System, or through telephone notification to the payer.
• Credentialing – with experienced credentialing specialists we can ensure that all information required is obtained from the practitioner and even complete all enrollment forms for insurance carriers.
• Coding – coders start by reviewing visit notes once they are locked and ensure procedure codes and ICD codes are accurate and reflect documentation. The notes are also scanned for any modifier that may be needed and everything is quality checked for completeness and accuracy.
• Contract Renegotiation ­­­– this can take a large toll on the revenue of a practice. We have a team that can analyze current reimbursement rates and determines which contracts need to be renegotiated.
• Documentation Management – many office staff is drowning in administrative tasks. Helping with document management by handling incoming faxes and ensuring they are assigned to the correct patient charts saves both time and money.
• Reporting – providing full transparency through the entire process by providing weekly, monthly, quarterly and annual reports.
• Account Management – every client is provided with a dedicated account manager who can be contacted with any questions and will see they are answered promptly.

As you can see, the above list of services goes way beyond the standard medical billing company and offers a truly holistic medical billing service option for physician offices of any size. In addition to the cost and time-saving benefits here are a few more:

1. Transparency – The entire workflow is documented in the software and can be accessed by you at any point. Having transparency in all the work, expectations, and communication allows you to be better informed and in control.
2. Fewer Errors – With professionals working in one system, using technologies to scrub and audit claims you can rest easy knowing your data is being properly input and accurate.
3. Reduced Costs – With fewer errors comes reduced costs. You may think it’s less expensive to keep billing in-house and try to perform the details of RCM with your current staff. The data shows this is not the case. Offices that hire a company to manage their revenue see an increase in reimbursement as well as a decrease in staffing costs. 4. Work Within Existing Systems – Unlike medical billing companies RCM can work within existing EMR/EHR software.

How to optimize healthcare revenue cycle

At Billed Right we provide RCM Solutions to help doctor’s practices grow. We understand that every practice is unique and therefore deserves a personalized strategy that works to improve patient care and increase practice revenue. Our goal is to not only ensure your practice gets paid but to be a strategic partner who will maximize your practice to its fullest financial potential.

If you want to begin saving money or have any questions and want to speak to a medical billing consultant contact us today!