Healthcare Billing vs Healthcare Revenue Cycle Management (RCM)
The healthcare industry uses billing and revenue cycle management (RCM) interchangeably. However, they indicate separate but linked processes. Billing is a specific part of the RCM process. It involves putting together and sending insurance company claims for payment of medical services given to patients. Medical billing involves registering individuals, verifying their insurance coverage, and completing and submitting the complete forms.
The other way around is that revenue cycle management (RCM) runs the whole process of getting money from healthcare facilities. It includes registering patients, verifying their insurance coverage, billing, making claims, posting payments, handling denials, and collecting from them. Billing is part of RCM. RCM assures that healthcare organizations get paid the most for their services by handling the whole revenue cycle.
Concepts Of Healthcare Billing
Healthcare billing is making and submitting claims to insurance companies to receive payment for medical services provided to patients. It is essential to the healthcare revenue loop and ensures that doctors and nurses are paid fairly.
Necessary Steps Of Medical Billing
Patient Information
Getting and checking a lot of basic information about a patient, like their name, address, phone number, and insurance coverage.
Insurance Verification
The patient’s insurance is carefully studied to cover the necessary medical services. The insurance plan, deductible, co-payments, out-of-pocket maximums, and any further authorizations must all be reported to it.
Medical Coding
Provide exact medical codes that accurately represent the diagnosis and course of therapy. You need to be well knowledgeable about medical jargon and proper coding.
Claim Submission
Collect the patient’s bills and submit them to their insurance provider by the guidelines and deadlines given by the provider.
Revenue Cycle Management (RCM) in Healthcare: What Is That?
Revenue cycle management (RCM) is the recording, monitoring, and collecting of revenue from healthcare services. It is a thorough procedure that guarantees payment for medical experts’ services.
Important Healthcare RCM Steps
Patient Access
Insurance Verification
Medical Coding
Claim Submission
Payment Posting
Denial Management
Patient Billing
What Makes Medical Billing And Healthcare RCM Different?
Medical billing and healthcare RCM are related, but some characteristics distinguish them.
- The larger RCM process includes medical billing as a particular position. RCM covers the whole revenue cycle, verifying insurance, billing, submitting claims, making payments, managing denials, and collecting from patients.
- Medical billing involves creating and sending in claims. RCM involves recording, controlling, and receiving income.
- Medical billing is usually done by people who work in billing. A group of workers in RCM are skilled in different parts of the revenue cycle, such as patient access, insurance verification, coding, claim filing, payment posting, denial management, and collecting from patients.
- Medical billing usually involves tasks that must be completed by a specific date and time, like when claims are due. RCM is a constant process that must be managed and watched constantly.
- Medical billing directly impacts the revenue cycle by assuring that claims are sent in on time and correctly. RCM significantly affects income because it increases cash flow, speeds up the process, and decreases rejections.
Final Thoughts
Both medical bills and RCM are essential in healthcare. Medical billing works by sending payment requests. There are many steps involved in getting money for healthcare services. Successful RCM and billing systems help medical companies make more money, keep their customers happy, and stay financially stable. Healthcare companies should know the difference between medical bills and RCM.