Medical Billing Services, RCM Services or In-House Billing: Which is Right for Your Practice?

Navigating the options for medical billing services isn't always straightforward. We'll guide you through the benefits of each to help you determine which solution is best for your practice.

The COVID-19 outbreak caused damage on a global scale. Early on, there was a great deal of financial uncertainty, which is presumably still being dealt with. Healthcare facilities bore a great deal of the impact. Patients postponed standard checkups and tests, procedures that had been previously planned were canceled, and many healthcare workers chose to leave the medical field. As a healthcare provider, you may still struggle with the resulting staffing shortages and income loss. Now more than ever, keeping a close eye on your company's financial stability is essential. Many practices have chosen to outsource their billing to third-party medical billing services or revenue cycle management services.

But which option is right for your practice, a Revenue Cycle Management service or a Medical Billing Service? In this article, we will help you distinguish the two and help you find the best solution that fits your business. Let's dive in.

Understanding Medical Billing Services

Female doctor using revenue cycle management processes for her medical practice.

Medical billing services save your team time by processing, submitting, and following up on health insurance claims and then billing the patient for the remaining balance. These services should use staff that has received specialized training, are aware of various payers, and can operate within the confines of each business's own set of rules to obtain a higher level of compensation in less time. Also, many medical billing services can follow up on denied claims and chase overdue bills.

It is common among many to use medical billing and medical coding interchangeably. However, they are two different things. Medical coding features the process of giving specific services standardized codes in order to submit claims. On the other hand, medical billing handles the actual processing, submission, and follow-up of claims. Some medical billing services might provide both, but many expect you to manage your own coding.

Medical billing services bring immense benefits to your healthcare practice. Some of the perks include:

  • Increased efficiency and reduced administrative burden on office staff.
  • Reduced misunderstanding relating to the specific payment policies of each payer.
  • Decreased submission errors.
  • Quicker processing of claims.
  • Improved access to qualified industry experts.
  • Reduced costs per patient.
  • Increased growth and profitability.
  • Better patient billing experience.

Understanding Revenue Cycle Management

Revenue cycle management (RCM) is a broader method that includes billing, collections, and payouts. This all-encompassing strategy can help your business become more financially viable by streamlining cash flow, lowering denials, and strengthening accounts receivable. It covers everything, including selecting eligible patients, keeping track of when and how to provide services, and coding, filing, and monitoring claims and payments. 

Revenue cycle management can be intimidating because of its sophistication. However, it is a special process that enables you to ensure the financial health of your practice so your patients can continue to receive top-notch care. Typically, the cycle starts every time a patient requests a time slot at the facility. After contacting insurance companies to check eligibility, the patient pre-registration process begins. This is where all medical data and coverage information is retrieved. This stage is essential to ensuring that the RCM runs smoothly and that money flows to the organization promptly.

This procedure increases productivity across the board and identifies issues like missing data early in the process, enabling providers to file claims faster and better understand the trends among their patients and the practice, identifying areas for improvement as well as procedures that generate the most revenue.

By integrating revenue cycle management into your business, you can make sure that each patient interaction leads to accurate claims and quick payments. You may prevent delays and interruptions when claims are rejected or underpaid by proactively approaching reimbursement. Also, a well-designed RCM system can assist you in developing a greater understanding of your AR. This enables you to see problems and take action more rapidly.

In-House Medical Billing Team

 Hospital receptionists processing patient payments - using medical billing services and revenue cycle management services.

If you intend to keep medical billing procedures in-house, you'll need at least one skilled medical biller on your team. This way, you can ensure the proper processing of all of your claims. The benefit of this approach is that you'll have a specialized medical billing team on staff, and this helps improve communication. 

However, an in-house team comes with increased overhead costs—employee benefits, paid time off, and sick time. You also risk staff turnover, and the cost of training new staff can be both costly and time intensive. An in-house team is also limited in capacity, especially when patient volume is high. When this happens, you may struggle to process claims efficiently, diminishing the quality of care and eventually lowering patient satisfaction.

Choosing the Right Solution for Your Practice

So which solution stands to benefit your healthcare organization the most? While both solutions have their perks, the answer to this will ultimately depend on your revenue goals, practice size, the patient volume you can handle, and staff resources. All these should come into play in your decision-making process. Otherwise, you'll risk spending resources that are not efficient for your business, even though they may benefit patients. You should consider the benefits from all angles.

With a revenue cycle management service in place, you are guaranteed that everything is taken care of for you. You'll better manage your billing procedures internally with fewer employees and worry less about billing. An RCM service can help track and control all facets of your health business's finances, eliminating a few stages in the claim submission procedure. 

RCMs provide the goal of enhancing medical billing and data collecting for all revenue. Sure enough, medical billing services are adequate to carry you through the first year of operation. However, if your practice is developing and growing, an RCM solution would better serve your long-term needs. The more your medical practice grows, the more it handles more patients and claims. And revenue cycle management is best suited to effectively facilitate that development.

Maximizing Revenue and Improving Patient Satisfaction

Integrating revenue cycle management - Male doctor explaining payment procedures to a patient during a consultation.

Having a robust revenue cycle management approach in place will help your medical business operate more effectively, increase revenue, reduce patient costs, and increase patient satisfaction while providing you with a degree of revenue transparency and insight that you have never had before. 

And in today's competitive market, it can assist your company in identifying issues like missing data so you can quickly fix them and submit claims. This way, you'll gain a competitive edge over your competitors and better understand your accounts receivable, identify trends, and get a far better understanding of the condition of claims.

BillFlash RCM Services provides an end-to-end solution for practices to outsource their medical billing. Our team of certified medical billers manages every aspect of the claim validation and submission process, effectively reducing denials and ensuring prompt payments. Our comprehensive reporting allows our clients to gain detailed insights into their revenue cycle, and increase their income. If enhancing the patient billing experience and improving your practice's cash flow procedures are top of mind, we are just a demo away.

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