When it comes to treating patients and saving lives, doctors, nurses, and clinical personnel are at the front lines. However, when it comes to maintaining the operation of these healthcare facilities and hospitals, revenue management specialists serve as the administrative heroes behind the scenes.
If you're exploring a career in health information and are curious about the roles and responsibilities of a coding and revenue cycle management specialist, we're here to help you break down the complexities of this multidisciplinary role. Below, we'll unpack what coding and revenue cycle management means and how you can get started on your path to pursuing this type of career.
What is Revenue Cycle Management in Medical Billing?
From patient registration to the final payment and revenue analysis, revenue cycle management (RCM) in medical billing encompasses the entirety of the patient revenue cycle to maximize revenue generation. By overseeing the accuracy and efficiency of the revenue cycle, RCM professionals optimize the financial performance of healthcare organizations. A role in RCM entails activities such as patient registration, charge capture, claims submission, payment posting, denial management, and revenue analysis.
Coding and Revenue Cycle Management (CRCM) vs Revenue Cycle Management (RCM)
Coding and revenue cycle management is simply the combination of two components: medical coding and healthcare revenue cycle management. This means that an RCM specialist is also responsible for overseeing the medical coding process in addition to the broader duties of revenue cycle management. Comprehensively, coding and revenue cycle management covers the following activities:
Health Information Management (HIM) vs. Coding and Revenue Cycle Management
Though these roles can often intertwine, health information management specialists are primarily focused on managing patient health information and medical records for accuracy, confidentiality, and accessibility. Similar to the way CRCM professionals oversee the entire revenue cycle, HIM specialists oversee the entire lifecycle of health information л from collection and storage to analysis and retrieval. They must ensure compliance with healthcare regulations and the accuracy of information exchanges between healthcare providers.
Medical Coding and Revenue Cycle Management Process | Key Elements
Now that we've covered the broader meaning of revenue cycle management, we can begin to unpack the specific elements that make up the process. While each of these elements may be referred to by different names depending on the facility you work for, the overall process generally remains the same.
Patient Pre-authorization
Before a patient is seen by some physicians or is eligible to pick up certain medications, they must go through a pre-authorization process where insurance providers determine whether they will cover a medication, service, or procedure.
Insurance Eligibility and Verification
Medical office software can include automatic checking of patient eligibility via the Internet over secure channels. Using dedicated revenue cycle management software can speed up the process of verifying whether a patient is entitled to a particular benefit. Revenue cycle management personnel are always at the forefront of this process.
Charge Codes & Charge Capture
Medical coding is at the heart of physician reimbursement, hospital payments, quality review, benchmarking measurement, and the collection of general medical statistical data. Coding the patient visit properly and in compliance with the individual payer requirements makes this element key to the successful generation of revenue.
Claim Filing and Submission
The submission of claims is the most vital stage in the overall process because the reimbursement directly depends on the claims submission being done properly. Coding and revenue cycle management personnel help ensure the payer is reimbursed in a timely manner and any potential errors are resolved quickly and efficiently.
Denial Management
In the case where a claim is rejected, the revenue cycle management professional steps in and resolves the errors, ensuring that the claim is scrubbed for coding errors and resubmitted.
Collections
When there is reduced reimbursement from the payers, meaning the health plan did not cover all the services, it is the revenue cycle professional's responsibility to follow up with the insurance company, make adjustments as needed, and document the errors for future consideration when billing.
Revenue Analysis and Reporting
One of the most critical responsibilities of a coding and revenue cycle manager is the overarching systemic analysis of a facility's financial data to gain insights. In this analysis, RCMs evaluate revenue trends and patterns, the effectiveness of charge capture processes, reimbursement patterns and sources, claim denial reasons, and coding accuracy.
After evaluation, coding and revenue cycle professionals must then communicate these findings in the form of financial reports, key performance indicators, trend analysis, and actionable insights. The final result is a continual optimization of the entire revenue cycle process that aims to maximize a facility's revenue and minimize inefficiencies.
How to Pursue Coding and Revenue Cycle Management Roles
One of the many benefits of pursuing coding and revenue cycle management is the variety of paths you can take and the multitude of niche roles within the overall field. Whether you initially specialize in medical billing and coding before expanding your horizons to additional education, are looking to supplement your bachelor's degree with additional certifications in RCM, or are starting your journey with an associate's degree and entry-level positions, no one road leads to a career in coding and revenue cycle management.
Get Started With the Coding and Revenue Cycle Management AAS Degree Program at CHCP
The Coding and Revenue Cycle Management Associate Degree Program at the College of Healthcare Professions provides training in the key skills you'll need to pursue your career in as little as 96 weeks. Credits from other related programs, such as the Medical Billing and Coding Certificate Program, may transfer to give you a head start on earning your degree. To learn more about the program and adjacent course offerings, get in touch today to speak to an admissions counselor and explore your options.
