The AMA’s updated CPT codes are now effective for 2023. Encompassing 393 editorial changes, 225 new codes, 75 deleted codes, and 93 revised codes, the changes strive to reduce administrative tasks and subsequently...
If you're new to the medical billing world, you may be wondering what a Revenue Cycle Management (RCM) team does. And rightly so - RCM is a critical part of the medical billing process. Understanding what an RCM team does can help you better comprehend medical billing services as a whole, which can, in turn, help you to enhance your organization's revenue cycle.
A lot to take in, we know. But don't worry - we're here to help. This blog post will explain what an RCM team does, and how they can help you with all of your medical billing needs. But first, what exactly is RCM anyway?
What is RCM?
Revenue Cycle Management (RCM) is the process of managing the financial aspects of a healthcare provider's business. This includes everything from patient registration and scheduling to claims processing and collections.
The goal of RCM is to ensure that providers are reimbursed for the care they provide in a timely and efficient manner. To do this, RCM teams work closely to streamline the medical billing process and improve provider reimbursement.
What are Medical Billing Services?
Medical billing services can be broken down into a few key components, and an RCM team is responsible for the "Revenue Cycle." The Revenue Cycle includes everything from when a patient first schedules an appointment, to when the last insurance payment is received.
In order to understand what an RCM team does, it's important to understand the medical billing process as a whole. Here's a quick overview:
- A patient schedules an appointment with a provider.
- The provider sees the patient and provides care.
- The provider documents the care in the medical record.
- The provider submits a claim to the payer (insurance company).
- The payer processes the claim and determines the amount they will reimburse the provider.
- The payer sends a payment to the provider.
- The provider applies the payment to the patient's account.
- Any remaining balance is billed to the patient.
As you can see, there are a lot of steps involved in the medical billing process. And that's where an RCM team comes in.
So, what do Revenue Cycle Management teams do?
Before we jump into what an RCM team does, it’s important to understand who makes up the RCM team. RCM isn’t just about the process, it’s also about the humans behind the process.
RCM really is a team effort between the front desk, the provider, and the RCM experts. Each play a critical role in achieving accurate and timely reimbursement.
We know that RCM teams are responsible for the Revenue Cycle, but what does that mean in terms of day-to-day tasks and who’s responsible for what? Let's find out.
Manage patient registration and scheduling
One of the first things an RCM team will do is manage patient registration and scheduling. This includes tasks like verifying patient insurance coverage, collecting copayments and coinsurance, and scheduling appointments.
When it comes to patient registration, it's crucial for RCM teams to make sure that all of the necessary information is collected upfront. This will save time and hassle down the road when it comes to submitting claims and getting reimbursed by insurance companies.
Submit claims to payers
Claims are like invoices - they detail the services that were provided and the cost of those services. Once a provider has seen a patient and documented the care, it's up to the RCM team to submit those claims to payers.
This process can be time-consuming, as each claim must be reviewed for accuracy and completeness before it is submitted. But it's essential to make sure that claims are submitted correctly, as errors can result in delayed or denied payments. Nobody wants that!
Review and appeal denied claims
Unfortunately, even with the best efforts, claims can sometimes be denied. When this happens, it's up to the RCM team to review the claim to see why it was denied, and then take the necessary steps to appeal the decision.
The appeals process can be complex, so it's important to have a team of experienced professionals on your side. RCM teams will know exactly what to do to get your patient's claims approved and get them the reimbursement they deserve.
Follow up on unpaid claims
Even when claims are paid, there can be a delay between when the services were provided and when the provider actually receives payment. This is called Accounts Receivable (AR), and it's something that all providers have to deal with.
When claim payments are delayed, it's up to the RCM team to follow up with payers to find out why the payment is being delayed and take the necessary steps to get the provider paid. This might involve submitting additional documentation or even appealing a claim denial.
Process payments and apply them to patient accounts
Once a provider has been paid, it's up to the RCM team to process the payment and apply it to the patient's account. This includes tasks like posting payments, issuing refunds, and updating patient balances.
You can't just leave money sitting in your account - you need to make sure it gets applied to the patient's balance so that they don't end up owing you money. That's why this is such an important task for RCM teams.
Bill patients for any remaining balance
After a provider has been paid, there might still be a balance remaining on the patient's account. This is called a patient balance, and it's the responsibility of the RCM team to bill patients for any remaining balance.
This can be a tricky task, as you don't want to overcharge patients or end up in collections. But as long as you work with experienced RCM professionals, they'll know exactly how to handle patient billing to ensure everyone is happy.
As you can see, there's a lot that goes into the revenue cycle management process. From managing patient registration and scheduling to submitting claims and processing payments, it takes a team of experienced professionals to keep everything running smoothly so that your practice can get paid.
If you're looking for a medical billing service that can handle all of these tasks for you, look no further than Practice EHR. We have a team of experienced RCM professionals who will take care of everything for you, so that you can focus on running your practice.
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