24 Nov Medical Billing Software for Revenue Cycle Management
Medical Billing Software with RCM
Over the last couple of years, the medical billing industry has introduced Revenue Cycle Management (RCM). This system is designed for financial management and to handle billing for medical professionals.
This hinders the job of medical billers and coders who spend years learning how to accurately devise invoices for insurance companies and individual patients. Many are leery of this system, but there are those who have also found it helpful.
Practice Revenue Cycle
Medical practices have a general revenue cycle to go by. This is a long process that can take 30 days or more to complete. The cost associated with the extensive billing process is added into the general office fee, so it is an unseen fee but does exist. The cycle includes the following 12 steps:
- Scheduling an appointment
- Insurance verification process
- Obtaining co-pays
- Office visit
- Coding process
- Claim checking
- Error resolution
- Claim submission
- Processing and posting payments
- Reviewing denials and appealing them
- Sending patient statements
True Revenue Profits and Losses
RCM programs show real time profits and losses for medical providers and major medical facilities. This shows where invoices have gone unpaid, if the rates are correct for the services rendered after overhead, and if ample revenues are collected to maintain the practice or medical facility. The RCM program is mostly beneficial to hospitals and large practices that have thousands of patients.
Better Collection Efforts
Alerts can be setup in some RCM programs to notify healthcare providers of unpaid bills by both patients and insurance companies. At this time, collections efforts can begin, such as sending a reminder, placing a phone call, or even refusing the appointment until the outstanding balances are paid. This is a common problem and is one of the main reasons that healthcare facilities suffer such great losses throughout the year.
Reduces Small Practice Financial Losses
Many physicians have implemented fees for no-show appointments after seeing the results from using RCM systems. This system is designed to help manage the financial aspects of the business, which includes lost revenues and patients not being seen in a timely manner due to no shows.
The average no-show fee is $25 nationwide. These programs also show where insurance companies dispute charges and request billing reductions and sliding scales for those without insurance. When losses are noticed this is an indication that an increase in service fees has to take place.
There are many benefits to using RCM systems in the medical industry. Some believe that these programs will eventually phase out the need for medical billers entirely as it will come down to simple data entry and coding. Those that have used these systems have seen increased revenues and have better managed practices.
Patients that refuse to pay their medical bills cause the rise in expenses for the nation as a whole. Implementing this type of system helps maintain accurate records and helps medical practices to be fully aware of their financial status at all times.