Understanding Revenue Cycle Management in Medical Billing

Revenue of a business is an asset that it receives from its commercial business activities like offering services or selling raw materials. And managing this aspect effectively is imperative for its success. Revenue Cycle Management is a practice that helps businesses confirm that their clients or customers have made payments to the bills on time.

RevenueCycle Management in medical billing is an innovative approach that helps judge, amend, and administer most of the components in gaining patient encounter information and further implement the same in order to guarantee complete patient safety. It also helps formulate a streamlined, and articulated work-flow design to optimize and accelerate claim reimbursement.

RCM, in a nutshell, is a process in which steps are taken to convince that a healthcare provider gets paid for the service he/ she offers in a timely manner. The Revenue Cycle starts as soon as the patient calls the medical provider’s office for an appointment and the staff acquires all the information like patient name and number along with the details about their insurance plan. The cycle traverses across several steps and terminates when the balance on a patient’s account is settled to zero.

Revenue Cycle Management in medical billing is comprised of certain key components. The patient registers for an appointment and all the relevant information including demographics and insurance is obtained. The insurance eligibility check or eligibility verification is conducted including an authentication check to ensure that a provider is billing the right insurance. An electronic system generates a medical claim form (CMS-1500, the most commonly used claim form) containing information about the services provided to the patient. This claim is submitted and is further tracked for reporting its reception, delivery, and acceptance by the insurance payer. The claims are compiled by the insurance companies and a follow-up process is executed.

The process of revenue cycle management in medical billing involves claim submission and follow-up with the insurance company. Payments are received in the form of EFT transfer or checks that are required to be posted in electronic software. This step concludes the charges entry and payment posting process. The claims that are left unpaid are followed up by an A/R denial management, or A/R collections & follow-up team. Final modifications are done to the denied claim and required supportive documents are submitted with the insurance. The process comes to an end when the patient account is settled and the invoice is closed.

The RevenueCycle Management process or simply RCM helps a medical practice gear up and accelerate its cash flow. It is a structured & organized process that aids in faster revenue collections.