We all know that medical billing companies have been around for years and years, it is not a new concept. So what is the difference between the standard billing company and revenue cycle management companies? This is an interesting and fun topic to explore and one I have become very passionate about. The old billing companies did just that, they entered and submitted your claims. Enter revenue cycle management companies who fulfill the complete cycle. Well, if the company you select is a true revenue cycle management company and not a billing company posturing under the name revenue cycle management. A true revenue cycle management company handles the entire revenue process not just the middle billing section.
Many practices are unaware what functions should be encompassed in revenue cycle management. The easy answer is anything that has to do with patient revenue should be covered under revenue cycle management. That is not to say that you have to elect all of those functions, only that they should be available as part of the service. For instance, eligibility verification should be a service offered as valid insurance and benefit eligibility are key components to a healthy revenue cycle. Tracking down current insurance and trying to collect missed co-pays and deductibles are both time consuming and costly to a practice. Verifying claims are coded to the highest level and scrubbed for submission is another critical factor. Denied and under paid claims can have a huge impact on a practice and wreak havoc to the bottom line. Everyone wants their claims to be processed accurately the first time and your revenue cycle management vendor should be improving your first time claims acceptance rates. Add to that contracted payment audits to verify that you are being paid accurately and you are on the right track. From here they move on to patient statements and collections. We know many times smaller dollar amounts are left behind as staff has to focus on higher priorities. Your RCM vendor should go after even the small dollar amounts and having a third party vendor handle the collection piece makes for a smoother patient interaction.
Here is my soap box moment, many companies that handle just the basic billing functions have elected to call themselves revenue cycle management companies. This is the new naming trend and they want to be part of this group. Unfortunately, they do not cover the entire revenue cycle and as such tend to cause confusion. Calling yourself a revenue cycle management company does not make you a good option. So if you are looking for a vendor to handle your RCM services, make sure you select a true revenue cycle management company and not a standard billing company in disguise.