By Leo John
What is Medical Billing in Medical Revenue Cycle Management?
Medical Billing is the process of creating healthcare claims to submit to insurance companies to receive reimbursement for medical services provided by providers and provider groups.
The biller tracks the claim after converting a healthcare service into a bill. A skilled medical biller helps to improve the revenue performance of a healthcare service provider.
The In-House Medical Billing Process
The Medical Billing service consists of multiple processes. The process might take anywhere from a few days to several months. The goal here is accurate billing and quick follow-up. In most cases, insurance companies are required to pay claims within 30 or 45 days. The late claim might be refused without the opportunity to appeal, and the organization is not reimbursed in that case.
Medical Billing service needs more effort and practice, as errors at any stage of the billing cycle can be expensive in terms of income and administrative effort. The performance of the front-end and back-end billing personnel involved here is critical to the financial health of medical practices and healthcare providers.
The Behind the Process Works of In-House Medical Billing Service
The Revenue Cycle Management process involves a series of processes to ensure a smooth payment process.
Patient Database
The foremost process in Medical Revenue Cycle Management is collecting patient data. It includes the patient’s demographics, information, address, insurance information, history, and much more. The medical biller collects all this data and maintains the records until the service is complete.
Medical Records
The personal data of the patient is not the complete record that Medical Revenue Cycle Management services require. It needs the medical data of the incident. The medical biller collects data from the physician about the patient’s diagnosis for insurance purposes
Medical Service Records
The medical service provided for the patient is recorded along with the service charge. This data helps the Revenue Cycle Management process identify and determine the associated insurance costs.
To maintain a consistent and accurate insurance plan, the Revenue Cycle Management healthcare system needs to collect and maintain all this data for individual patients. The Medical Billing service really starts here!
The Medical Revenue Cycle Management Service Process Doesn’t Stop with Data Management!
Medical Billers’ actual responsibility starts with negotiating the reimbursement for healthcare services with individuals, healthcare providers, and insurance companies. The reimbursement negotiations are based off the collected patient data and insurance history. This data is verified by the Medical Biller before submitting for the claim.
The Two Types of Medical Revenue Cycle Management’s in In-House Medical Billing Process
The Medical Billing process can be divided into front-end and back-end process. Front end billing process refers to services prior to service—that is, before the service is provided to the patient. In this process, a front-end billing personal maintains all the data and information of the patient.
The back-end billing process starts after the patient has completed the initial appointment with the healthcare provider. This back-end Revenue Cycle Management solutions do not involve patient directly.
Front-End In-House Medical Billing Process
Front-end Medical Billing in Revenue Cycle Management strategy requires a professional practice. The biller who’s familiar with the organization’s insurance payers and health plans. They must be a trained billers to identify insurance eligibility while also remaining aware of filing deadlines.
Registration
The Revenue Cycle Management process for processing an insurance claim begins when the patient registers for an appointment with the doctor. After the registration, the data collection process begins. Here, a Medical Revenue Cycle Management service provider needs to follow a standard procedure to maintain an accurate database.
Eligibility Verification
Eligibility Verification involves a verification of patient’s insurance eligibility such as the dates, patient coinsurance, copay, deductible, and plan benefits.
Financial Approvals
The patient is now informed about the financial details after the verification of insurance claim eligibility.
Check Out
The front-end staff schedules follow-up appointments as needed and ensures that the insurance form is updated. Medical coders obtain the patient’s medical records and convert the billable information into medical codes after the patient has checked out.
Back-End Revenue Cycle Management Services of In-House Medical Billing
The back-end process of Revenue Cycle Management involves various stages and documentation to ensure the revenue flow is maintained.
The Charge Entry
In Revenue Cycle Management solutions, Charge Entry refers to the process of calculating the amount of reimbursement that the provider will receive from the insurance payer.
Claiming Process
After finalizing the charges and payments, the claiming process is initiated. The Revenue Cycle Management service process claiming is based on the data derived from the bill generated.
Claim Submission
Bill claims are submitted through clearinghouses, which provide a variety of services, including the review of claims for compliance with payer policies and federal regulations. The clearinghouse will return claims that require corrections to the biller before forwarding the corrected claims to the payer.
When the claim reaches the payer after passing through the clearinghouse, the data file is processed and converted to a claim form for the claims revie
.
Claim Tracking
Claim-submitted bills must be inspected on a daily basis. When a claim reaches the payer, adjudication begins. Adjudication refers to the process of reviewing a claim and determining whether or not a payer will pay the provider. So, this should be tracked.
Payment Posting
Payments must be posted on the day the physician starts the practice, along with accompanying checks or direct deposits. The Revenue Cycle Management service provider must verify that the billing matches payments to patient accounts, reconcile payments against claims, and confirm the data. Finally, Medical Billers must reconcile direct deposits received and posted.
Denial Management
When an insurance provider denies a claim, the remittance advice includes a denial code with a brief explanation. The billing staff should review the denied claim to determine if additional information is required, if errors need to be corrected, or if the denial should be appealed.
What are the Benefits of Handling Billing Services In-house?
We are clear on all the processes and procedures of Medical Billing services. If you ask whether you can handle the Revenue Cycle Management billing process in-house, then here’s few points to consider.
- If you are small patient population healthcare and handle fewer insurance claims per year, it’s usually better to keep billing in-house.
- Another advantage of doing Revenue Cycle Management on-site is that when billing and coding issues arise, you can expect them to be resolved more quickly because the team is nearby.
- When your Revenue Cycle Management process is handled in-house, you can track them anytime you require.
- You can easily address any issue of your Revenue Cycle Management system when managed in-house.
- Every additional in-house employee is an increase in costs.
- If you have limited members in your billing team and suddenly the insurance counts rise, finding immediate resources can be difficult.
- When all the billing papers are handled by an organisation, there are less possibilities of human errors.
- You need to share your focus between Revenue Cycle Management and patient care.
What Can Outsourcing Revenue Cycle Management Service Bring to Healthcare?
Outsourcing your hospital’s Revenue Cycle Management entails bringing in an outside team to handle all of your administrative tasks related to billing, coding, and other non-provider-related tasks. This allows your entire team to concentrate on helping people rather than worrying about how to maintain the Revenue Cycle Management process.
Outsourcing your Revenue Cycle Management should reduce Medical Billing and Coding errors while also streamlining patient and insurance provider collections. This will help to ensure that all of those funds that were pending have been collected completely.
You no longer need to invest time in hiring, training, and managing billing staff if you outsource RCM. Outsourcing RCM allows you to devote more time to making the most of your medical expertise, improving patient care, and expanding your practice.
When you hire a professional Medical Billing service provider, all your billing-related processes are professionally managed. The Revenue Cycle Management agency will handle all the related billing operations with accuracy and efficiency.
Furthermore, the outsourcing of Revenue Cycle Management services can cover all possible revenue generation process for your company. They will handle everything, from negotiating with insurance companies to following up for delayed payments to disputing claim denials.
On the whole outsourcing your Revenue Cycle Management services can benefit you more with operations as well as patient experience. When you outsource your Revenue Cycle Management healthcare services, look for a company like MHRCM that provides the following benefits,
- Denial Management
- Eligibility Verifications
- Medical Coding Optimization
- Charge Capture and Billing
- Accounts Receivable Follow Up
- Patient Collections
- Claims Review and Submissions
FAQs:
Will Outsourcing Revenue Cycle Management Services Reduce Denials In My Healthcare Service?
Outsourcing Revenue Cycle Management services to experienced professionals at MHRCM improves your practice. Our service will significantly reduce the number of denied claims.
Will Outsourcing Revenue Cycle Management Services Enable The Tracking Of All The Patient Claims?
Yes. When you outsource your Revenue Cycle Management services to MHRCM, we keep a constant and accurate track over all the bills, claims and denials, maintaining the right follow up service for you.
Can Investing In RCM Outsourcing Save My Healthcare In The Long Term?
Yes. It does save your healthcare services in the long term when you find the right RCM company like MHRCM to operate all your healthcare Revenue Cycle Management systems.
Will Managing My Healthcare Revenue In-House Make A Difference To My Service To Patients?
It depends on the number of bills you manage per day. If you are managing less than 500 bills a day, you can operate in-house until your bill counts expands. It is best to outsource your Revenue Cycle Management strategy to companies like MHRCM for an accurate and clean service.
Will Your Outsourcing Company Provide Me Guidance On The Pending Bills And Updates?
Yes. We will provide you all the necessary and timely updates about the bills, follow ups, claims and denial managements transparently.
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