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John Martinez

Revenue Cycle Management vs Medical Billing Software

November 22, 2022

EHR, RCM 3 Minute Read

Medical billing is a critical process that physicians cannot ignore. This is how you and your staff get paid and, importantly, keep the doors of your practice open.

Before submitting a claim to a patient’s health insurance company, those in charge of medical billing must document the costs of any procedure performed. This process is made more efficient through medical billing software, usually referred to as Practice Management software. An alternative option for medical billing is Revenue Cycle Management services. RCM often includes a bundle of software (Electronic Health Records, and Practice Management software) as well as an outsourced team of specialized billers to help with medical billing.

Today, using a software solution for your medical billing needs is the norm, but deciding on which route to take will greatly affect how you run your practice and how efficiently it’s managed.

How RCM works

An RCM solution will include a bundle of software and a specialized team of outsourced billers assigned directly to your practice. An RCM service should handle the process of registration, charging, coding, sending claims, communication with insurance, billing, and ultimately, receiving payment. This gives practices a record of every step in a particular claim. Additionally, this allows backtracking when confronted with any issues and adequate tracking of the practice’s revenue gains.

What’s Medical Billing vs RCM?

The task of medical billing is the responsibility of your staff and management team, who input patient information and handle all billing procedures needed for timely payment. The additional assistance RCM offers goes even further than traditional medical billing by allocating an outsourced team of billing specialists that will monitor, track, and correct all billing processes along the way, including coding, insurance verification, outstanding accounts receivable, and much more.

The Benefits and Best Choice for a Practice

When picking the best solution, both traditional medical billing software and RCM services have their advantages. If you plan on keeping your medical billing in-house and using Practice Management software, you will need at least one experienced medical biller to make sure all of your claims are being processed correctly. The benefit of having a dedicated medical billing staff in house is ease of communication. The main benefits of using an RCM service would be that all of the software is included, you need less internal staff to manage billing, and you can spend less time worrying about billing. All aspects of the practice’s finances are well-tracked via an RCM software program, eliminating a few steps in the claims submission process. With RCM a practice can keenly keep track of all incoming and outgoing costs and, by extension, predict and determine the outcome of certain individual claims.

Choosing what’s best for your practice comes down to your needs. RCM was designed to improve medical billing and collection of all revenue information. Perhaps in the first year of operating your practice, medical billing software will be sufficient, but if your practice is growing and expanding, an RCM solution will probably meet more of your long-term needs. As a practice gains new patients, it processes more claims and hires additional staff. Simply put, RCM tools enable that growth more effectively than simply medical billing applications.

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