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Understanding What Medical RCM Is and Can Mean for Your Practice

Understanding What Medical RCM Is

The definition of revenue cycle management is simple but the implications for your practice can be significant.

Understanding what Medical RCM is can be the difference between earning the revenue you need to thrive as a practice or operating on thin financial margins.  Revenue Cycle Management, or RCM, is the function that all practices, groups, and health systems have in place to, at a minimum,

  • Verify patient eligibility and benefits
  • Validate and submit claims for payment
  • Collect payment from both payers and patients

Of course, actually collecting that revenue is rarely that straightforward!  Managing patient expectations and interactions, working denials, and ensuring that your organization collects what it is owed is much more complex than 3 bullet points.  That complexity is the reason many healthcare organizations choose to outsource their medical billing.

Reasons to outsource medical
billing services (or RCM)

Operating a healthcare organization becomes more complex with every passing year. There are new regulations, coding updates, changing payer rules, and performance measures that can significantly affect reimbursement.

Deciding to outsource medical billing simplifies an organization’s administrative process and provides the highest return on investment for their revenue cycle management dollars.  Healthcare organizations know it’s time to outsource medical billing if or when they are not collecting the revenue that they should be.  Early warning signs that you are on the path to sub-optimal collections can include:

  • When the claims are piling up but revenue isn’t. This is a sure sign that an organization will not be collecting all of the revenue it’s due because of timely filing rules.
  • If the only metrics or analytics for the billing department are bank deposit slips. Having zero or limited insight into your revenue cycle can mean money left on the table.  Be sure to check out our medical billing metrics and best practices!
  • If there isn’t enough time in the day to work denied claims or follow up on rejections. Taking care of patients is priority #1 but if revenue cycle demands keep pushing to tomorrow then the practice needs to evaluate if existing workflows can be improved, the organization is understaffed, or the needed billing and coding expertise is missing.

The work of a medical billing company starts at patient registration and continues through until claims are paid

When healthcare organizations outsource medical billing they are outsourcing much more than just the submission of claims.  With Medusind, the work starts at the beginning of the patient visit lifecycle: the appointment.  Whether it’s a new patient that was just registered or an existing patient who has set a new appointment, we verify that patient’s insurance eligibility and benefits.  The results are near-instantly and automatically populated into the proprietary RCM technology we provide for your healthcare organization.

Providers then treat the patient and, depending upon level of service, either generate a superbill or provide clinical documentation to be coded onto a superbill.  It’s important to point out that with Medusind, you can keep your EHR!  If you like your electronic health record or clinical software we want you to keep it!  Our RCM technology will seamlessly integrate with it.

Next, the superbill is scrubbed and validated against our rules engine to ensure the claim is clean and has the highest probability of being paid on the first pass.  Then, the claim is submitted to the payor and the response to the claim plus any other electronically available information is populated into MedClarity, our RCM technology, with total visibility for the practice.

Medusind then works denials and handles all interaction with the payer to be sure the claim is paid to contract and the practice collects what is due.  Check out the results we drive for practices below.

Grow Your Business with Medusind RCM Results 

Anesthesia Billing Company

10%-30%

Increase in
Cash Collected

What Medical RCM Is

$2,000,000,000

More than $2 Billion in
Charges Billed Per Year

Dental Billing

95%

Average Clean
Claim Rate

Medical RCM FAQ

20% Improvement

Days in A/R

What RCM Is

3,000,000 +

CPT and ICD-10
Coding for more than
3 Million Charts

Medical RCM

30% +

Improvement in Self Pay
Collections 

How outsourced billing and collections can

drive revenue for your practice

A medical billing service can increase revenue for your practice by identifying revenue opportunities that are not obvious without the right RCM technology and without the human expertise to find these opportunities.

In the form of a cost savings, it is expensive to hire certified billers and coders at healthcare organizations with one FTE averaging $35,000 per year in salary alone.  Partnering with a medical billing service helps reduce the ongoing need to hire this type of help.

It’s important to note that just because you partner with a medical billing service doesn’t mean the billing department will be losing their jobs.  It’s important for continuing practice operations to have employees with knowledge of billing and collections to serve as a liaison to the billing company.  And, where efforts were 100% focused on billing, that labor can now be re-focused on patients.

What Medical RCM Is

Benefits of medical billing services for small practices in particular

Small practices of all specialties have much to gain when partnering with a billing service.  As previously mentioned, the lack of appropriate technology (or training on the existing technology) and lack of knowledge around the latest medical billing rules and regulations can make maneuvering through the revenue cycle difficult for smaller practices.

We see that in many smaller practices there are not enough employees to effectively manage all aspects of the practice all of the time.  By outsourcing the billing and collections efforts you’re allowing your existing staff to focus on what matters most- your patients.

Knowing when to outsource medical billing for your practice

The time to outsource your medical billing is when you recognize or get the feeling your organization isn’t collecting the amount of money it should be, plain and simple.

Whether there is a clear need for revenue cycle help or it’s something your healthcare organization is curious about we are happy to provide an analysis of your current metrics to understand how much improvement in your revenue can be made.  Don’t hesitate to contact us with any questions about medical RCM, learn about our medical billing service, or hit the contact page to request a free practice analysis.

Medical RCM