What is Medical Billing Management?
Medical billing is submitting and following up on claims with health insurance companies to receive payment for services rendered by a healthcare provider or medical billing company.
To better understand what medical billing management is, let’s define the parties in this process:
- The patient
- The healthcare provider (hospitals, physicians, physical therapists, emergency rooms, outpatient facilities, and other places where medical services are performed)
- The insurance company or payer
So, the role of medical billing management is to arrange payment between these three parties. Specifically, the billing manager ensures that healthcare providers are compensated for their services by billing patients and payers.
The process looks the same for most insurance companies, whether private companies or government-sponsored programs. This interaction is called the billing cycle, sometimes called Revenue Cycle Management.
Revenue Cycle Management (RCM) administers financial transactions resulting from medical encounters between medical billing parties.
From registration and appointment scheduling to the final payment, they are all a part of the revenue cycle.
Here is what’s involved in the revenue cycle:
Data Collection
Inputting data about a patient: its name, birth date, and the reason for a visit, and insurance information: the name of the insurance provider and the patient’s policy number verified by medical billers. This information is used to set up a patient file that will be referred to during the medical billing process.
Claims Transmission
Passing claims from the care provider to the payer.
Claims Management
Includes claims processing, vetting, and analysis if it’s rejected.
A/R Follow-Up
Ensures that medical billing companies have a way to recover overdue payments. Most responsibilities include looking after rejected claims, exploring partial payments, and reopening claims to receive maximum reimbursement from insurance companies.
Reporting
Includes financial data, management information, and key performance indicators to recognize the results and to get an overview of the state of the process.
So, it’s crucial to organize the medical billing system as an essential part of Revenue Cycle Management. With an excellent internal RCM setup, healthcare providers can quickly resolve issues and ensure a steady revenue.
Medical Billing Management Overview
Medical billing management is critical individual in the health care system.
To overview the whole process, let’s consider it from the position of the responsibilities associated with the role of medical billing manager. The medical billing manager’s most important task is overseeing the billing process of patients and insurance companies.
The job includes collecting, analyzing, and reviewing data to determine the appropriate charges and managing patient accounts receivable.
- Cooperating with insurance companies regarding insurance contracts
- Training and supervising team members to ensure that all of them always follow proper medical coding practices
- Accepting fees from patients, insurance firms, and government health programs
- Arranging and maintaining all paperwork and records
- Communicating with clients about their bills
- Tracking payments made by insurance agencies and patients (analyzing and reviewing data to determine the appropriate charges and managing patient accounts receivables)
- Testing software programs to ensure the efficiency of the system
Maintaining proper inventory of supplies such as forms, envelopes, stamps, medical record paper, etc.
A medical billing manager also ensures that employees and customers follow all policies.
Lots of the tasks above are manual and repetitive. If you approach medical billing management from the automation point of view, then RCM will become much more efficient.