Healthcare Business Management Association - HBMA
Login
About HBMA About HBMA - HBMA Healthcare Business Management Association

Medical Billing & Revenue Cycle Management

What is Medical Billing?

Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a healthcare provider or medical billing company (interaction between a health care provider and the insurance company (payor). The same process is used for most insurance companies, whether they are private companies or government sponsored programs. The entirety of this interaction is known as the billing cycle sometimes referred to as Revenue Cycle Management.

Revenue Cycle Management

Revenue cycle management (RCM) is the process that manages claims processing, payment and revenue generation. It entails using technology to keep track of the claims process at every point of its life, so the healthcare provider or medical billing company doing the medical billing can follow the process and address any issues, allowing for a steady stream of revenue. The process includes keeping track of claims in the system, making sure payments are collected and addressing denied claims. RCM encompasses everything from determining patient insurance eligibility and collecting co-pays to properly coding claims using CPT and ICD-9 should be ICD-10 codes. Time management and efficiency play large elements in RCM, and a physician's or hospital's choice of an EMR can be largely centered around how their RCM is implemented.