Healthcare Billing and the Revenue Cycle – It Works like a Factory

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RPM Billing provides excellent healthcare billing and revenue cycle management services to its clients. The “revenue cycle” is a set of key clinical and administrative processes, which occurs in a coordinated fashion alongside each patient’s service, and ultimately collects all of the data needed in order to bill for that service. Important data elements that are needed for billing, such as the patient’s name, address, gender, birth date, insurance information, services rendered, and diagnostic codes are gathered in the revenue cycle. Think of the revenue cycle as a series of inputs, and billing as the output. Problems in the revenue cycle result in challenges for the billing office.   

We help our clients clearly identify and prioritize the issues causing the most payment delays and we are always working together with them for maximum impact.
— Jonathan Marshall, MBA, President of RPM Billing

Think of inputs and outputs and it becomes clear that healthcare billing and the revenue cycle are like a factory. As scary as it may sound: the revenue cycle is the factory, and billing is the sales department. Take a car factory, for example. There are numerous inputs. You need doors, a windshield, four tires, a steering wheel, an engine, and so on. If all of those things are brought in timely, and placed accurately, then you have a factory producing cars that can be sold. The sales department can take those cars and turn them into cash, and the business is working. If your factory only puts three tires on each car, or sometimes forgets windshields or steering wheels, then you won’t sell any cars. In fact, you would end up with a massive inventory problem along with a lot of money and time wasted on re-building the cars so that they can actually be sold.

In the healthcare billing factory, the inputs are demographic information, insurance information, billing codes, diagnostic codes, and sometimes authorizations and referrals, etc. As the patient receives care, a team of clinical and administrative staff are responsible for gathering and recording all of this information in a timely and organized fashion. In today’s environment, this typically happens in Electronic Medical Record (EMR) computer systems, but some healthcare providers still use paper-based systems as well. At the end of each day, the billing office gathers all of this information and uses it to create bills and sends them to insurance companies. If the information is all accurate and timely in the revenue cycle (factory), then the billing office (sales department) is typically able to get payments on those bills within 15-45 days. If any of the information is wrong or missing (the car’s missing tire now shows up as the incorrect insurance authorization number), the insurance company rejects the bills instead of paying them. At this point, a good billing office (sales department) will go back to the revenue cycle (factory) to help to re-work each bill. But also in this situation, there are now more bills to be worked and tracked (inventory problem), meaning more billing staff are now needed. The result of errors in the revenue cycle (factory) is delays in payment by 45-100 days, and a lot of time and money wasted in the extra effort to fix things. Some billing offices won’t provide any feedback to the revenue cycle at all, creating a system in which money is repeatedly left uncollected. Most billing offices don’t use analytics, so they lose track of the all the bills, don’t prioritize which ones to fix, and don’t accurately explain how much money is being left on the table.

Here at RPM Billing, we not only work and track 100% of the bills at all times, we take this one very meaningful step further. Through advanced analysis and consistent communication, we are able to build a bridge between our office and our clients’ offices in order to better help them better manage their revenue cycles. This means we help our clients clearly identify and prioritize the issues causing the most payment delays and we are always working together with them for maximum impact. Additionally, we create an environment of teamwork featuring positive attitudes, mutual accountability for performance, and shared goals. As a result, our clients know what we are working on, they know what’s going on in their AR, they have true partnership and positive communication from their billing service, and we get them paid quicker. All of our clients have experienced 15-100% improvement in collections, reduced AR, and improved communication and service compared to their previous billing resource.

RPM Billing is a medical billing and consulting firm based in Las Vegas and Reno, Nevada, and serving doctors, hospitals, and other healthcare providers nationwide. We have an experienced billing team, and we work with our clients to develop processes that make sure 100% of the encounters get processed, billed, and paid appropriately and timely. Led by Jonathan Marshall, who holds a Healthcare MBA and two decades of experience as CEO, CFO, and COO of hospitals and physician practices, RPM Billing was created as the answer to all of the overpriced and underperforming billing offices out there.  We are 100% committed to excellent service, processes, results, and ethics. To contact us for a free review of your company’s opportunities to improve revenues, please call us at 775-501-9820, email us at jon@rpmbilling.com, or visit us at www.rpmbilling.com. Thank you.