Medical Billing is the process of following up the claims with the health insurance companies in terms of receiving the reward/payment for the services delivered by a medical billing company or healthcare service provider. The same procedure is applied for most of the insurance companies, doesn’t matter if they are private organizations or government programs. This whole process is known as Billing Cycle which is also referred as Revenue Cycle Management.
Revenue Cycle Management
Revenue Cycle Management is the leader of the financial transactions that is the output of the medical encounters between a patient and the service provider or the supplier. These includes, without limitation, collections, billing, provider enrollment, data analytics, management, coding, and compliance.
RCM unites the business and clinical sides of healthcare service supplier by combining the administrative data. Which are as follows- patient’s name, insurance service provider and other relative information and details.
The revenue cycle includes all the leadership and clinical functions that result in the capturing, managing and collecting the service revenue of patient which is due to the Healthcare Financial Management Association.
These are the following things involved in Revenue Cycle;
- Charge capture– Exhibiting medical services into the form of billable charges.
- Claim submission– Providing claims of billable charges to the insurance companies.
- Coding- Accurately coding of the procedures.
- Patient collections– Analyzing patient’s balances and receiving its payments.
- Pre-registration– Gathering pre-registration information like insurance coverage.
- Registration- Gathering ensured patient’s information at the time of registration to establish a number of medical records and meet multiple requirements of the financial, regulatory and clinical situations.
- Remittance processing– Accepting or rejecting the payments made through remittance processing.
- Third-party follows up- Getting the payments/reward from third-party insurers.
- Utilization review– Researching the necessity of medical services.