What is Medical Revenue Service – Overview
Medical Revenue Service (MRS) is crucial to the business aspects of healthcare facilities, such as hospitals and clinics. Critical administrative tasks such as charge capturing, billing, and revenue cycle management are crucial operations that MRS professionals are equipped to manage effectively.
Revenue services in the medical and healthcare industry are essential for a healthcare provider’s smooth day-to-day operations. They can be provided by an in-house MRS professional or by hiring a third-party vendor.
Revenue services in the medical industry primarily include billing, collection, and revenue cycle management. While marketing campaigns are important for a healthcare facility’s growth, they are generally not considered a core component of Medical Revenue Services. These services also use proper medical coding practices to ensure prompt and accurate billing and payment.
In this article, we will examine medical revenue service and its importance in the medical industry.
What is the Medical Revenue Service (MRS)?
A medical revenue service provides revenue management to healthcare professionals, groups, hospitals, and other healthcare systems. Its staff is specially trained to handle the billing and collections aspect of medical practice so that healthcare professionals can focus on patient care.
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These services help doctors collect money from insurance carriers or patients, besides ensuring that the revenue stream stays open and grows.
Numerous companies offer excellent medical revenue services today. Many healthcare professionals, hospitals, clinics, and other healthcare facilities hire these MRS vendors mainly to provide comprehensive medical billing services.
Additionally, these services assist with essential administrative and organizational tasks, streamlining operations within the client’s healthcare facility. These companies also offer to perform claims processing, insurance verification, and even patient registration.
These MRS providers are essential for large hospitals and small medical facilities alike.
What Does Medical Revenue Services Include?
As mentioned earlier, the Medical Revenue Service includes many different kinds of services. Here are some of the major ways that MRS helps healthcare providers and facilities maintain a streamlined administration and revenue cycle.
What Does Medical Revenue Services Include?
1 – Prevent revenue cycle leakage
Revenue cycle leakage occurs when the healthcare provider cannot determine which patients are behind in paying pending bills. This creates a problem as the patient may choose not to visit the doctor, and they may lose revenue.
To prevent this, an MRS professional can ensure accurate billing and coding, double-check to ensure the patient has provided correct information and details, and avoid revenue cycle leakage.
2 – Manage Medical Coding and Billing
Medical billing and coding are interrelated and help ease payment between patients, health insurance companies, and healthcare providers. Professional medical billers are responsible for processing patient payments and insurance claims with the insurance carrier.
Medical coding professionals work to review the patient’s diagnosis and ensure that the codes are in order so they can assign the correct billing code.
As medical professionals like doctors and surgeons are not trained in medical billing and coding, the MRS professional can handle that aspect of their healthcare facility.
3 – Ensure streamlined revenue generation
There are two types of medical billing done in a healthcare facility:
First, professional billing happens when a patient visits a healthcare provider at a hospital, clinic or other healthcare facilities. This also includes independent doctor’s offices. The payment process involves sending a bill to the insurance carrier who reimburses the healthcare provider.
Medical billing and coding experts perform the two major functions supporting a hospital or clinic’s revenue cycle, ensuring accuracy and compliance with healthcare billing regulations. Professional billing is aimed at billing claims generated for services provided by healthcare professionals, suppliers, and non-institutional providers, including inpatient and outpatient services.
On the other hand, institutional billing involves handling the bills for clinics, hospitals, rehab facilities, nursing homes, etc. It involves inpatient and outpatient services, along with the expense of laboratory, equipment, and ancillary services.
The main difference between professional billing and institutional billing lies in the scope of billing activities. Professional billing focuses on services provided by healthcare professionals, whereas institutional billing encompasses billing for facility-based services, including the use of equipment and supplies. They are not responsible for the coding or documentation required to provide these services.
Due to the complexity of hospital coding compared to clinic-based coding, healthcare facilities often hire medical coding and billing professionals with specific training tailored to the environment they will be working in, whether it’s in a hospital or clinic setting.
How Does the Medical Revenue Service Work?
The medical revenue service starts after the doctor has examined the patient and decided on a medical remedy. The MRS professional then sends an invoice for the services to the patient’s insurance carrier, which decides if the claim should be reimbursed. Once the claim is processed and approved, the required payment is sent to the hospital or clinic.
Contrary to a common misconception, medical billing and coding is a specialized field that requires comprehensive education and training, including an understanding of medical terminology, billing software, and compliance with healthcare regulations. However, this is far from the truth, as medical coding and billing professionals undergo challenging training to get certified. This is especially tough for candidates without experience in the medical or healthcare industry.
An MRS professional also offers other services, such as conducting financial clearance. This involves maintaining and verifying patient information before the patient arrives for the appointment. In addition, it is essential to maintain accurate and updated billing records to ensure patients are billed correctly.
These services also help streamline the admission and discharging process at hospitals and inpatient and outpatient facilities. The patient information process must be streamlined during check-in and check-out. This helps to avoid double-checking and redoing the entire paperwork later on.
Essential medical documents are necessary for successful financial clearance. In addition, it ensures that regulatory practices are followed so insurance carriers can reimburse for services more promptly.
Lastly, an MRS professional also ensures that an effective electronic charge capture process is used. This includes recording the patient’s information, such as treatment type and billing data before the patient arrives at an appointment.
Conclusion
Medical revenue services are essential to ensuring the smooth running of any healthcare provider’s administrative aspects. MRS professionals are trained in medical billing and medical coding of all types and can effectively handle professional and institutional billing.
An MRS provider helps ensure that the healthcare provider can focus on the health service aspects without worrying about proper billing and coding for prompt payments.
See Also
HHS HIPAA Regulations and Requirements
What is Advance Premium Tax Credit
Cultural Competence in Healthcare
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