What is Medical Revenue Cycle Management?
What is medical revenue cycle management (MRI)? Revenue cycle management is a method by which electronic medical billing systems interact with electronic patient billing systems to obtain information from a medical claim. These electronic billing systems exchange data between electronic clearinghouses, physician statement applications, and payment processors to complete a successful financial transaction between payers, health care providers, and patients. This transaction is called the Medical Reimbursement Cycle (MR TC).
Purpose of the Medical Revenue Cycle Management
The purpose of the Medical Revenue Cycle Management (MRI) is to provide timely, accurate, and integrated billing and claims processing. In other words, MRI is designed to make it easier for a payer, a health insurance carrier or a physician collaborating with a payer, a health insurance agent or a physician to follow-up on an insurance claim that the payer, the health insurance carrier, or the physician has submitted for processing. Through MRI, the following happens: First, the payer, the health insurance carrier, or the physician submits the claim for processing to the appropriate clearinghouse. Second, the appropriate clearinghouse receives the submitted claim, analyzes the information provided by the health insurance carrier or the physician, and submits the claim to the insurer, if it is one of its policyholders.
The main objective of the MRTC is to improve the quality, timely processing of insurance claims and hospitalization, surgery, and medical services performed. There are many components of the MRTC. One of them is the Electronic Medical Records (EMR) system. The EMR software is responsible for converting electronic medical records, which are generally sent to payers via the Internet or through faxes, into a convenient format that can be read by an authorized subscriber to the system. Thirdly, the EMR software is also responsible for storing these electronic medical records. The record will then be transferred to the insurer after it has been processed.
Medical Revenue Cycle Management (MRTC) uses three primary modules: the electronic claims entry system (ETRS), the claim entry system (CES), and the claims billing and coding system (CXC). A team of highly qualified and experienced professionals, known as claims auditors, works in close collaboration with the physicians, surgeons, and other staff members. Through teamwork, they examine every aspect of the various aspects of the EMR and CMS. They ensure that all parts of the system work smoothly to provide fast, accurate, and valuable medical treatment to their clientele.
The objective of Medical Revenue Cycle Management
Another important objective of MRTC is the improvement of clinical functions. The objective is to promote improved quality of service revenue cycle management. In addition to the quality of service, improved clinical functions ensure greater patient satisfaction. An improved patient satisfaction enables the health care providers to build a strong and positive relationship with their patients.
The main objective of CMS is to offer accurate, clear, and complete medical diagnosis, procedure codes, diagnosis information, procedural plan, treatment information, and insurance information. The improved efficiency and improved quality of services provided by the Medical Revenue Cycle Management System lead to an improved financial performance by reducing errors and claims. It is an important part of the overall quality improvement efforts in healthcare. CMS improves the claims processing rates, reducing administrative costs and eliminating patient claim rejections due to incorrect or outdated information. CMS helps to improve the quality and safety of the healthcare environment by ensuring compliance with national guidelines and applicable laws.
Medical Revenue Cycle Management also ensures that all costs are documented and that the proper patient care procedures are implemented. This enables easy tracking and analysis of the medical records for future reference. In addition to documentation, MRTC needs to provide a mechanism to share the medical records electronically. For this, a centralized data repository and registration system are required. A comprehensive software package and a practice quality manager should be employed for this purpose.
Today, the Healthcare Industry is witnessing tremendous growth and competition. In such a scenario, there has been mushroom for companies providing healthcare business solutions in the form of Medical Revenue Cycle Management systems. CMS can be considered as an essential part of the entire medical billing process. Therefore, the demand for a robust and reliable MRTC solution in the Healthcare Industry will continue to rise. Further, with a proper MRTC solution, it will become easier for the healthcare industry to comply with national and state regulations for taxation, licensing, and certification.
What are the Benefits of Having Medical Revenue Cycle Management?
The benefits of these revenue cycle solutions include improved cash flow, reduced staffing requirements, enhanced productivity, reduction in operating costs, and improved quality of care. Improved cash flow is a direct result of improved billing, collection, and accounting practices. With this in place, businesses are able to meet their obligations to their patients and pay their expenses on time. Delays in payment or denial of payments result in diminished revenue and losses in profitability. Improper billing practices result in patient harassment and the denial of needed treatment.
Medical billers and accountants can prevent these problems by improving their billing practices and procedures. To do this, providers must make sure that all claims made are authorized by the patient, and that all required documentation is generated on time. Medical providers must also keep abreast of new medical technology and medical trends to determine which procedures may pose a risk to the client. Medical billers and accountants must be proficient in the assessment and collection of claims and must maintain excellent collections of these claims. By doing so, they allow their customers to receive the best possible care at reasonable rates.
The company offers a wide range of services to medical coding and billing specialists. Some of the services include electronic claim submission, assignment of claim number, renewal monitoring, management and collection of claim information, and audit support. The company offers services to assist with claim preparation, electronic data collection, electronic clearinghouses, and the audit function. Their portfolio includes a full range of product lines and services that are designed to help medical providers and their clients meet their goals.