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Medical Billing vs. Revenue Cycle Management

woman sitting at laptop with two other people explaining the difference between medical billing vs revenue cycle management

Any competitive company wants to exercise control over its accounts payable (AP) and accounts receivable (AR). The behavioral healthcare industry is no exception. However, many treatment centers focus on medical billing rather than the entire revenue management cycle (RCM). While accurate and timely billing is important, there are advantages to a more comprehensive, data-driven approach. When considering behavioral health revenue cycle management, Sunwave Health offers a unified, data-driven software platform specifically designed for behavioral health.

Reach out to schedule a demo and learn how Sunwave Health can create competitive advantages and efficiencies in your behavioral health treatment facility.

What Is Medical Billing vs. Revenue Cycle Management?

Medical Billing

Medical billing is the process of submitting and tracking claims to insurance companies to receive payment for services rendered. The process starts when a patient begins medical care and ends when reimbursement is received, which comprises payments from insurance and the patient. In between, several steps must be completed accurately and promptly for the insurance company to process the claim and issue a payment. Medical billing is a complex and ever-changing process, and it is crucial to clearly understand the different steps involved.

Revenue Cycle Management (RCM)

Revenue cycle management (RCM) is a more comprehensive approach that encompasses billing, collections, and payments. This holistic approach can help your organization improve financial viability by optimizing cash flow, reducing denials, and improving accounts receivable.

Integrating RCM into your organization can help to ensure that every patient encounter results in clean claims and prompt payment. By taking a proactive approach to reimbursement, you can avoid the delays and disruptions that can occur when claims are denied or underpaid. In addition, a well-designed RCM system can help you to achieve greater visibility into your AR, allowing you to identify issues and take corrective action more quickly.

RCM can help your organization improve its bottom line by streamlining claims processing and payment collection. In addition, by providing greater transparency into the revenue cycle, RCM can help you to make more informed decisions about areas of need or opportunity. As a result, RCM is an essential tool for any organization that wants to optimize its financial performance.

Medical Billing Services vs. Revenue Cycle Management for Inpatient Operations

When managing revenue for inpatient stays, there are two main options: medical billing services and revenue cycle management. Medical billing services involve outsourcing the billing process to a third party, whereas revenue cycle management is focused on improving efficiency and financial viability across all aspects of the revenue cycle.

There are several benefits to using revenue cycle management for inpatient stays. For one, it can help streamline and optimize the billing process, which reduces the risk of denials and improves collections. In addition, RCM offers greater visibility into your organization’s financial performance, allowing you to make more informed decisions about your operations and financial needs. Finally, RCM can help you to achieve greater control over your revenue cycle and improve the overall health of your organization.

A third-party medical billing service could result in less insight into the accounts receivable process. By placing control in the hands of a third-party, inpatient facilities lose the ability to adjust quickly to changing data. Any problems that arise will have to be negotiated between the patient, the facility, and the third-party billing service.

Medical Billing Services vs. Revenue Cycle Management for Clinics and Treatment Centers

The same options exist at a behavioral health clinic or treatment center as for inpatient facilities: a medical billing service or revenue cycle management. However, inpatient facilities and outpatient clinics are not treated the same by insurance companies. To further complicate things, some providers are non-profit or state-run. In contrast, others are private—this adds further complexity to billing and receiving payment from insurance companies.

A reputable third-party billing service faces the same challenges for a clinic or treatment center as with an inpatient facility, except additional services may be offered in a private behavioral health environment that are not offered in an inpatient setting. Being able to bill and collect efficiently is essential.

A revenue cycle management system allows for greater customization and provides insights that allow for data-driven decisions.

Sunwave Health Offers Behavioral Health RCM Solutions

In any healthcare setting, including behavioral health, having a detailed understanding of how revenue flows into the business is crucial to remaining competitive and profitable. For some, a third-party billing service may suffice, but a data-driven software-based RCM approach offers greater customization and insight into billing, insurance reimbursement, and collections.

Sunwave Health offers a unified software platform incorporating RCM in addition to electronic records management, customer resource management, and a host of other business tools designed specifically for behavioral health.

Schedule a demo today or call 561.576.6037 to learn how we can help.