RCM refers to Revenue Cycle Management. This is increasingly trending nowadays. The main objective of RCM is to maintain a smooth revenue flow. The number of procedures in institutes is increasing tremendously. Hospital staff has very little time to complete the billing process.
It is necessary to understand what is RCM in medical billing. Although RCM and medical billing are part of the same category, there are a few typical differences. It is essential to understand the differences for efficient working.
Virtual Healthcare is one of the most renowned Medical billing companies. Healthcare RCM is the process of billing the services. This starts from the time of admission of the patient till the time of the payor’s final payment. On the other hand, medical billing only refers to certain steps in the RCM.
RCM is the complete process, while medical billing is one particular step in that process. The RCM mainly focuses on the overall revenue flow of the institute. Medical billing is one of the steps in the RCM process.
RCM is a multiple-step process. It is essential to understand the complete process. The different steps in the RCM process are –
- Scheduling – The process starts with the scheduling process. A proper RCM process always schedules the patient in advance. This is only avoided in case of emergency.
- Verification and eligibility – At the time of scheduling, ensure the collection of complete patient’s data. This data helps in determining the type of insurance coverage for the patient. Predetermination would enable the institute to raise any claim requests early. Also, informing the patients about the excess charges, if any, are possible at the time of admission itself.
In some cases, the insurance companies require an authorization letter as well as a copy of the medical records. Completing these steps on time helps in swifter settlements.
- Patient admission – On completion of the pre-admission steps, the patient take-in process starts. This includes the treatment process that the patient undergoes. The complete procedure is precisely captured on the EHR (Electronic Health Record). In some cases, the paper record is still maintained. Patient data is also collected by administrative staff at the institute.
- Medical transcription – In certain cases, the medical details are not directly fed into the record. The practitioner dictates the details to a third party, who does the process. Updating the EHR of the patient accordingly.
- Medical billing and coding – One of the most complicated processes in RCM is coding. The coding is basically in 2 steps. Procedure codes (CPT) are 5-digit codes that represent the services. This includes all procedures the patient undergoes. The second part is the diagnostic codes (ICD10). This represents the disease or the medical condition that brought the patient to the institute.
- Claim submission – This is the heart of the RCM process. All the codes along with the demographic details of the patient are put together. Submitting them to the insurance companies for the settlement process later for settlements.
- Payment posting – This simply refers to the payment made by insurance companies to healthcare institutes. In certain cases, the settlement amount is not complete. In such cases, the patients have to pay the remaining charges. The patient statement shows the amount payable by the patient.
- Secondary billing – In some cases, the patient has multiple insurances. In such cases, once the primary insurance company makes the payment, the bills proceed to the secondary or tertiary insurance companies. This depends on the information available in the system.
- Patient billing – Re-verification and submission by an expert again in case there is a denial. Situations where the denial is due to non-coverage, then the patient receives the statement. This is statement processing.
- Accounts Receivable – This basically shows the charges that are still not received. Overall the main aim of the AR team is to collect the pending, underpaid, or the denied insurance claims. Basically, insurance follow-ups and patient follow-ups are the 2 different types of Accounts Receivable follow-ups.
- Denial management – This process starts whenever there is a denial. Identifying the real reason behind the denial and then following up with the patient to receive the payment. Apart from this step, all other steps are a complete package in RCM. Certain companies skip this step.
Revenue cycle management is an integral part of healthcare institutes. Therefore, improving RCM is essential for the overall growth of the institute. That s why, understanding what is RCM in medical billing gives a proper insight into the different factors of RCM.
Virtual Healthcare provides the best medical billing solution. The experts take care of each and every step of the RCM process.