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Medical Billing vs. Revenue Cycle Management

a person looks over the shoulder of another while looking at a laptop and explaining the differences 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 entirety of revenue cycle management (RCM). While accurate and timely billing is important, there are advantages to a more comprehensive, data-driven approach. Understanding the differences in medical billing vs. revenue cycle management can help you determine the best approach for your business.

When considering behavioral health revenue cycle management, Sunwave Health offers behavioral health treatment solutions in a unified, data-driven software platform. Reach out at 561.576.6037 to schedule a demo and learn how Sunwave Health can create competitive advantages and efficiencies in your behavioral health treatment center.

Differences Between Medical Billing and Revenue Cycle Management

There are some key differences between billing and RCM to consider. Below are basic breakdowns of these two terms:

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

Revenue cycle management 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.

Benefits of RCM

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 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 vs. Revenue Cycle Management for Inpatient Operations

When managing revenue for inpatient stays, it’s vital to chart and document services rendered so they can be charged and collected accurately. 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, including:

  • Optimization – RCM software can help streamline and optimize the billing process, which reduces the risk of denials and improves collections.
  • Insights – RCM solutions offer greater visibility into your organization’s financial performance, allowing you to make more informed decisions about your operations and financial needs.
  • Control – Finally, RCM can help you achieve greater control over your revenue cycle and improve the overall health of your organization.

Relying on a third-party medical billing service could result in less insight into your accounts receivable process. By placing control in the hands of a third party, inpatient centers 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.

Utilizing RCM in Outpatient Clinics and Treatment Centers

The same options exist at an outpatient behavioral health clinic or treatment center as for inpatient care: a medical billing service or revenue cycle management. However, inpatient centers 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 center, 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.

Custom services are more likely to be billed or disputed inaccurately when they are completed by third-party billing companies, which can make them appear ineffective. A revenue cycle management system allows for greater customization and provides insights that allow for data-driven decisions.

Integrating RCM in the Patient Journey

Looking at revenue cycles from the perspective of the patient can help to identify opportunities for improvement.

  • How easily could a patient get an appointment, receive care, and make payments?
  • Was billing clear and accessible?
  • Are there complications with private insurance or Medicaid reimbursement that require paperwork or additional effort on behalf of the staff?

Answering these questions requires an integrated approach that takes into account all facets of revenue cycle management.

At Sunwave Health, we focus on the entire patient journey. Our integrated software platform brings together all of your RCM and patient journey needs into a single system that is tailored to your organization’s specific requirements.

Call Sunwave Health to Find Offers for Behavioral Health RCM Solutions

Having a detailed understanding of how revenue flows into your behavioral healthcare center is crucial to remaining competitive and profitable. While a third-party billing service may help you get by for a while, 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.