Medical Revenue Services are the backbone of a hospital's or clinic's business. Without them, how would you manage revenue? These services include charge capture, billing, and revenue cycle management. These specific services can be provided by hospitals or third-party vendors who offer them. The importance of these services is that they help with the daily operations of a medical institute or hospital. 

Medical Revenue Services can include many different things within each service such as patent billing, collections, and marketing campaigns. Some healthcare providers even offer to consult on improving patient satisfaction within your facility or teach staff members about proper coding techniques so you can get paid appropriately for what you provide at your clinic.  One healthcare provider offers software programs designed specifically for hospitals to manage all incoming payments from insurance companies while still maintaining control over them.

This article will help you understand the different medical revenue services provided and how they can help your facility.

What Is Medical Revenue Service?

Medical Revenue Services help provider groups, hospitals, and different practices with revenue management. They all need these services because they specialize in taking care of patients and not collecting money from insurance carriers or said, patients. The important thing about these services is that they will help you get the right amount of money, and they can also help you take care of your patient's needs to keep them happy and healthy.

Medical Revenue Service Vendors

Different companies offer these Medical Revenue Services. For example, you can hire vendors to provide medical billing services. They will help the hospital with all their needs so that they do not have to waste their own time with essential office work.  You can also hire a vendor to perform insurance verification, claims processing, and even patient registration.  These Medical Revenue Services are necessary for many large hospitals and smaller medical facilities as they can all benefit from these services.

Revenue Cycle Leakage Points

A leak in the revenue cycle makes it so providers can't see who is paying their bills. This creates a problem because the patient might not come back to revisit the provider. There are many ways to fix this leak, but one way is to have an open house or talk about your prices with them before they pay you.

How To Prevent Leakage

It is important to perform billing and coding correctly. For example, it would be best if you hire a vendor that knows how to do this work for you as they will double-check your work and give you the correct information so that it does not enter in any leakage points.

Using Medical Revenue Services

It is important that you are careful about how to work with associated healthcare revenue cycle management services. There are different ways to use these services, but it may be best to hire a vendor with the skills and experience required for this job.

For more information on healthcare revenue cycle management, please click here!

Medical Billing and Coding

Medical billing and medical coding are two interrelated jobs that help facilitate payment between health care providers, insurance companies, and patients.  Medical billers work in an office to process patient payments and insurance claims within the healthcare providers, while medical coders review the patient's diagnosis and codes in order to assign the corresponding billing descriptor.

Doctors are not required to have knowledge of either medical billing or coding to provide quality care, but it is beneficial for all parties involved if they are knowledgeable in this field.

Although many individuals are not trained for this job, various community colleges offer programs in Medical Billing & Coding that will provide the necessary skillset.

Types of Medical Billing


There are two types of medical billing that can take place within the healthcare facility:

●  Professional Billing

The billing takes place when the patient comes into the facility and is seen by a provider in that office. This can also refer to physicians who practice in their private practice independent of a hospital or clinic.

Professionals bill for their services, and the insurance company will reimburse them. 

The first thing that one must understand about professional medical billing is that it is an office-based tool.  Professional medical billers often perform both billing and coding, which are the two main functions that support the office-based revenue cycle. Professional billing is responsible for billing claims generated for work performed by physicians, suppliers, and other non-institutional providers for both outpatient and inpatient services.

The billing process begins when the patient visits the doctor. The provider will document the services provided and submit a claim to the insurance company. The medical biller is expected to understand a little coding and is able to code and assign codes to each service and procedure. The codes are used to create a bill which is then sent to the insurance company. The insurance company will process the bill and reimburse the provider.

The billing process can be complex, and it is important to understand the basics of how it works. By understanding professional billing, you can better understand how your medical expenses are processed.

It is very important to know how to use your billing software before you make any huge transactions. The software packages may be expensive, but they are worth the investment if they help you with the core operations of your practice. One must also ensure great customer service is offered by their vendors, as customer satisfaction is key in this industry.

Click here to view billing updates for 2021 

●  Institutional Billing

Medical billers who focus on facility "institutional" billing are required to handle the billing for hospitals, clinics, rehab facilities, nursing homes, etc. This includes inpatient and outpatient services, as well as the use of equipment, laboratory, and ancillary services.

Medical billers in this field must also have a good understanding of medical coding, as well as the CPT, HCPCS, and ICD-9-CM codes. They are also responsible for billing insurance companies for services provided by physicians who work in these institutional settings.

The biggest difference between Institutional billing and professional billing is the fact that Institutional billing services handle the billing and collections process only. They do not handle any of the coding or documentation that goes into providing those services. Hospital coding is much more complex than physician coding, so hospitals usually hire a specific coder to handle that part of the process.

This is a more specialized field of medical billing, and it requires a good understanding of how hospitals and clinics operate. Billers in this field must be able to handle the billing for a variety of services and procedures. They must also be able to work with a variety of insurance companies.

Billing is a tough gig. Professional and institutional billers have an important job, but they need to know how it's done if they want success! There are some key aspects of the profession that every successful billing professional needs in order for their company or organization be profitable with excellent service:

  • How to submit medical claims efficiently for each insurance company
  • How to avoid violating HIPAA privacy and security rules
  • How to take advantage of the training software providers offer. If necessary, contact them when issues arise.
  • Knowledge of coordination of benefits information means knowing how to bill claims in the correct order to prevent a delay in payment
  • Understand how each part of a medical claim represents information collected from the time the patient schedules an appointment until the patient receives services.

This is only a snapshot of the key areas that all medical billers should be knowledgeable in. By understanding these key areas, medical billing staff can provide better service for their customers and increase the financial stability of the organization by quickly billing and collecting payment for services.

The financial stability of healthcare organizations can be determined by how quickly they bill and receive payment for services. This is where medical billing plays an important role in any facility which provides health care services to patients. Patients not only want their insurance claims processed correctly, but they also expect their payments to be received quickly so that they can pay their own bills. Click here to learn about how we bill our customers using our RCM

Medical Revenue Service Payment

A doctor would first need to examine the patient and decide what is required to remedy their medical situation. The doctor then provides the necessary care, after which the medical billing process starts with institutional or professional billing. The hospital then sends an invoice for services rendered to the patient's insurance company, which will determine whether they will pay for the treatment. If approved, they send payment to the hospital.

Many people are intrigued by the medical billing industry because they think that since it doesn't require much education, it will be easy to learn. This is definitely not the case. It requires a lot of work and can be challenging, especially if you have no previous experience in this field or any prior knowledge of coding or the healthcare system.

If a healthcare provider determines that a patient will need to have surgery, the doctor will provide the appropriate care. In many cases, the hospital is viewed as a necessary third party in this process.

The most important thing to remember concerning hospital billing is that insurance companies are going to want an itemized list of costs associated with the treatment.

This can be difficult for a surgeon to do without knowledge of medical billing and coding. It's best if the surgeon knows how these records are structured before they provide their services, or they could end up spending more time on their records than on the procedure.

Common Revenue Cycle Best Practice Metrics

The best practices used in the revenue cycle are essential for keeping an organization financially stable. One of the most important metrics to measure success is the time it takes to collect payments. This metric can be found by calculating invoice days. Payment Days = (Invoice Date - Invoice Due Date) divided by 365.

Another important measure is how many days or months elapsed before payment was made. This metric is determined by dividing 365 by the number of invoices due after one year. It should range between 30-60 days, but anything beyond 120 should be considered too long and will need adjustments to be made.

An important part of any healthcare business's revenue cycle is medical billing software that provides accurate coding and interoperability with EHR systems. It is essential that the software system used by healthcare facilities can interoperate with insurance companies as well as automatically bill for coding and reimbursement updates from the federal government. 

It has been found that medical billing errors cost two to three times as much as they would have had there not been an error in the first place. Therefore, it is important for medical billing companies to provide top-quality support and services which will help prevent these errors.

Medical billing software is one of the most important tools available for any healthcare facility looking to improve its revenue cycle management. Suppose you lack an efficient, effective system in place. In that case, it can result in excess costs and decreased revenues, meaning your business could be draining resources rather than helping your bottom line.

Conduct Financial Clearance

○ This includes maintaining and verifying patient information before the patient arrives for their appointment. It is important to have accurate, up-to-date billing records in order to ensure that patients are being billed appropriately.

○ These records are also vital for successful financial clearance. Financial clearance ensures that procedures are being correctly reimbursed by insurance providers. They are also necessary for locating errors after the appointment has been completed, if applicable.

Streamlined Check-In & Check-Out Process

The patient information process is important in the streamlined check-in and check-out processes. This ensures that they will not have to go back and redo paperwork at a later time. These documents are also vital for successful financial clearance. Financial clearance ensures that procedures are being correctly reimbursed by insurance providers. They are also necessary for locating errors after the appointment has been completed, if applicable.

Charge Capture

An electronic charge capture process is utilized.

○ This involves submitting a patient's information, such as billing data and treatment type before the patient arrives for their appointment. It is important to have accurate and up-to-date billing records in order to ensure that patients are being billed appropriately.

Charge Entry

→ A medical provider enters charges into the new system once they have reviewed the bill for accuracy and is within healthcare industry regulations. Any necessary adjustments will need to be made on the computer screen before charges can be submitted electronically.

Bill Reviewing

→ Insurance verification and review should be done by a medical provider before charges are submitted electronically. Once this has been completed, charges should be able to be filed within 15 minutes of entry. This process should also include checking for any errors.

○ This includes maintaining and verifying patient information before the patient arrives for their appointment. It is important to have accurate, up-to-date billing records in order to ensure that patients are being billed appropriately.

Credit reporting agencies use the medical billing software to collect patient debt information, which they then sell or distribute to fair debt collection practices or agencies.

Coding Information

→ Billing software automatically updates itself with coding changes, so there is no need for third-party coding services.

○ This includes maintaining and verifying patient information before the patient arrives for their appointment. It is important to have accurate, up-to-date billing records in order to ensure that patients are being billed appropriately.

Insurance Verification

→ Medical providers need to verify that insurance policies are current before submitting charges. This is to ensure that future adjustments are not needed.

→ If verification fails, billing software will alert medical providers of potential insurance fraud or other red flags so they can contact the patient before moving forward with billing procedures.

Proper Claims Management

Electronic claims are submitted, and status updates are frequent; a secondary claim process happens. Medical providers offer claims electronically to the insurance company, usually done in less than one minute. They will receive an update confirming receipt of the claim within five minutes but will not be told if it was accepted or denied until the next day. This provides peace of mind for patients because they know that their claim has been submitted and the medical provider has the necessary information for treatment.

Patient Statements

→ Medical providers can generate statements for patient billing in the event that they are over-billed. This is also necessary when there is a reimbursement issue. It is important to have accurate, up-to-date billing records in order to ensure that patients are being billed appropriately.

Payment & Denial Posting

This phase includes the entering of payments; the managing of contractual write-offs. This is to ensure that there are no claim denials for patients due to clerical errors. It is important to have accurate, up-to-date billing records in order to ensure that patients are being billed appropriately.

Insurance Follow Up

The electronic billing process involves submitting a patient's information, such as billing data and treatment type before they arrive for their appointment. It is important to have accurate and up-to-date billing records in order to ensure that patients are being billed appropriately.

Medical providers enter charges into the new system once they have reviewed the bill for accuracy. Any necessary adjustments will need to be made on the computer screen before charges can be submitted electronically.

Before medical providers submit claims electronically, they need to verify that insurance carriers are receiving claims and that the claims are being processed. This includes checking if there are any overdue or unpaid balances on an insurance policy before accepting any more claims from a patient. Insurance verification programs involve double-checking for potential fraud or other red flags that can alert a provider of any issues.

○ After the initial claim status is received, patient statements are often sent out as a secondary means for collecting payments from patients. Medical providers can also generate statements for patient billing in the event that they are over-billed. This process should include checking for any errors or omissions that may have been made in the initial claims process.

○ The final phase of insurance billing is payment and denial posting. This includes entering payments, managing contractual write-offs, and ensuring there are no claim denials for patients due to clerical errors.

Denial Management

Denial management works as a way to identify and prevent false claims. This means that you can see your denial rate, which will let you know if it is excessive or not. If the denial rate is high, then you may need to find out why that might be. You could be billed incorrectly or in a case of fraud.

It would help if you also audited your billing software to ensure it doesn't have any errors. It can be helpful to work with a cybersecurity expert for this process. They can fix any bugs in the software and help you identify any phishing sites on your website.

Patient Collections

○ During the patient collections phase, patient billing occurs, and collection letters are sent. Medical providers can generate statements for patient billing in the event that they are over-billed. This is also necessary when there is a reimbursement issue. It is vital to have accurate, up-to-date billing records to ensure that patients are being billed appropriately.

○ The final phase of insurance billing is payment and denial posting. This includes entering payments, managing contractual write-offs, and ensuring there are no claim denials for patients due to clerical errors.

The Debt Collection agency usually uses medical billing software in the background when filing an insurance claim. The debt collection agency then sells or distributes collected debt information to other agencies.

Credit reporting agencies can help you to find information about a patient's credit score, overdue payments, and outstanding debt. This is an excellent way to ensure that potential patients have the ability to pay for services in a timely manner.

Payor Management

In this phase, attention is paid to fee schedules. Medical providers enter charges into the new system once they have reviewed the bill for accuracy. Any necessary adjustments will need to be made on the computer screen before charges can be submitted electronically.

Before medical providers submit claims electronically, they need to verify that insurance carriers are receiving claims and that the claims are being processed. This includes checking if there are any overdue or unpaid balances on an insurance policy before accepting any more claims from a patient. Insurance verification programs involve double-checking for potential fraud or other red flags that can alert a provider of any issues.

○ After the initial claim status is received, patient statements are often sent out as a secondary means for collecting payments from patients. Medical providers can also generate statements for patient billing in the event that they are over-billed. This process should include checking for any errors or omissions that may have been made in the initial claims process.

○ The final phase of insurance billing is payment and denial posting. This includes entering payments, managing contractual write-offs, and ensuring there are no claim denials for patients due to clerical errors.

Summary:

In conclusion, the RCM system that Enter.health developed is a great tool for tracking collections and payments for medical revenue management. Industry experts have developed the software with years of experience in medical billing to be comprehensive yet easy to use. Plenty of modules will help you get started on the right foot, including patient scheduling, cash flow reports, expense reporting, and more! This month's blog post was about Medical Revenue Services- how does it work? We hope this information helped answer any questions you had about what these services entail or if they're something your practice should consider implementing. If not, feel free to reach out anytime - our team would love to chat with you further so we can learn more about your goals and see how we can help.

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