Difference Between Medical Billing and Revenue Cycle Management

In-house Medical Billing

Initially, physician’s offices had a person in-house that handled everything having to do with billing for the practice. This person added to the overhead of the office – about 10 – 12% and handled everything from A-Z in the billing process. General knowledge of codes was all that was needed to ensure reimbursement from insurance companies as this was before managed care.

The beginning of managed care brought to the industry fee schedules, preferred provider contracts, the need for pre-authorizations and more. These changes meant a more intensive knowledge of medical codes was required as well as continuing to keep updated as codes were added and deleted.  These changes increased cost and time required to handle billing.

Outsourced to Medical Billing Companies

Initially, physician’s offices had a person in-house that handled everything having to do with billing for the practice. This person added to the overhead of the office – about 10 – 12% and handled everything from A-Z in the billing process. General knowledge of codes was all that was needed to ensure reimbursement from insurance companies as this was before managed care.

The beginning of managed care brought to the industry fee schedules, preferred provider contracts, the need for pre-authorizations and more. These changes meant a more intensive knowledge of medical codes was required as well as continuing to keep updated as codes were added and deleted.  These changes increased cost and time required to handle billing.

In-house Medical Billing

After listening to what clients were asking for, a more robust system was created that covered more than just standard medical billing. This full-cycle revenue management system saved doctors time and money by eliminating the need to have different people handling all other aspects. Revenue Cycle Management includes:

• Insurance Eligibility – insurance verification and patient eligibility details checked two days ahead of a patient’s appointment ensuring 100% upfront collection.
• Charge Posting – ensuring demographic information is entered in the system accurately helping to eliminate rejections or denial from the payer which can prolong the reimbursement turnaround time
• Documentation Review – once visit notes are locked coding team retrieves a random sampling of the weekly visits to review and ensure proper guidelines were followed. We also provide education to the doctor and staff on their usage of CPT/ICD -10 to help them improve on future documentation
• Claim Submission – claims are reviewed and scrubbed to ensure that all information in the claim is correct to help eliminate a denial
• Denial Management – when payment for services is denied, we follow up with the insurance carrier to determine if it is a coding error or something else that has facilitated the denial. We complete appeals and add any supporting documentation submitted through your software
• Payment Posting – critical to the health of your AR – insurance payments posted to patient accounts from EOB’s in the doctor’s system with a turnaround time of 24 to 48 hours. With daily payments accessible via the practice management system

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