EMR vs EHR and Medical Billing vs RCM

Medical Billing vs. Revenue Cycle Management

All those associated in any way with a medical practice know about medical billing and how important it is. Proper coding of CPT and DX information, proper pre-certifications and pre-authorizations, proper insurance plan and patient demographic entry, charge scrubbing, charge entry and electronic claims submission, clearinghouse and insurance carrier error editing, co-pay posting, ERA, EFT and all other payment posting, secondary claim and paper claim submittals, appeals, response to request for additional information, patient statement processing and collections management – all of these processes are familiar to those engaged in medical billing. The truth is that there is a lot that goes into managing medical practice billing well, and it is tempting to think that the term “Revenue Cycle Management” is just a new name for an already well-established set of processes, but that would not be the case. Revenue Cycle Management does include effective management of all traditional medical billing processes, but it also includes much more, focusing on all elements required to assure that a medical practice maximizes reimbursements in a fully compliant manner, net of all costs. That means that all necessary processes and functions should be fully integrated into and account for one another, including clinical processes affecting reimbursement - medical billing should not be a disconnected set of processes performed in a vacuum. Precision’s revenue cycle management focus engages the entire practice in reengineering workflow processes, formatting practice management software functionality to provide efficiencies for key staff functions, integrating electronic health record software features into medical billing processes, and then working effectively together as a team to manage those reimbursement-driven processes well. And as things change over time, adjustments and reengineering is done, as necessary, to keep the RCM processes effective and on target. Because of Precision’s broad scope of capabilities and services, from practice management software to hardware, network and web support, from clinical EHR software to medical billing services support, and with Precision’s size, experience and broad exposure to many practice specialties and practice types, Precision’s Revenue Cycle Management services are comprehensively and effectively delivered to each and every client practice.

EMR vs. EHR

“Electronic Medical Records” is an older term, now replaced by the term “Electronic Health Records”, and the two are often used interchangeably. But there is a historical difference in that years ago, clinical software was focused specifically on converting paper records to an electronic format. Other important clinical processes and functionality were not part of the equation – EMR was all about converting a practice to the use of an electronic patient chart instead of a paper chart. Although a noble goal and daunting on its own a few years ago, it was realized almost from the start that electronic medical record software ultimately needed to do more and be able to add value to the entire clinical process – that clinical staff should be able to use a clinical software system to do much more, including the management of all clinical tasks, whether currently involving paper or not. A truly effective clinical software should allow a doctor to write prescriptions electronically, to order labs and other tests electronically, to allow a doctor to create office notes, surgical notes and referral letters effectively and without paper, and to support effective revenue cycle management (e.g. electronic superbill). And today “interoperability” and “patient health records” are terms coined to incorporate the concepts that patient medical information should be portable yet secure, in order to allow for better, faster and less expensive clinical treatment among healthcare providers. That is what Electronic Health Records is all about.