Legion Healthcare Solutions

What is the Difference Between Medical Billing and RCM?

What is Revenue Cycle Management

At their core, Medical Billing Services and revenue cycle management solutions aim to facilitate the collection of financial data from healthcare providers. However, there are some major disparities between the two. This blog helps you understand these differences. Moreover, this article tries to answer the question of whether you should hire a Certified Professional Coder or Healthcare Revenue, Cycle Manager. How they help the administrative management of a hospital or clinic. 


What is Medical Billing?


Medical Billing is a process that has the following steps:

  1. A medical staff renders the medical history from a patient.
  2. After that the medical staff forwards this to the insurance companies.
  3. Follow up with the insurance companies to know if the insurance company covers the following service or not. Moreover, it can help to know what amount is the patient’s responsibility and what amount the insurance company will pay.
  4. After the appointment the staff files a claim and follows up till the insurance company pays the assured amount.


It is essential that this exercise is done rigorously so that the physician gets the due amount for the services he renders. It is not necessary that a doctor appoints a medical staff for this purpose. Private or third-party organizations with Expertise In Medical Billing Services can do this job very easily. A number of small and large practices bank on Medical Billing Companies and outsource their work. This helps these medical and dental practices to concentrate on their core job and save a lot of money.


Now let us find out about the concept of Revenue Cycle Management (RCM ) of Healthcare.


What Is Revenue Cycle Management?


Revenue cycle management is also known by the short name RCM. The Revenue Cycle Management Process comprises many stages. Medical billing is one of these stages. The main work of a revenue cycle management company is to execute all the administrative processes of the practice. The processes include the following:

  1. Collect the history of patients
  2. Notify the upcoming appointment date to the patients
  3. Get the required information from the insurance companies in regards to the claim
  4. Maintain a balance between the payer and the patient.


As Healthcare RCM Providers we have seen that many physicians confuse between medical billing and revenue cycle management. However, both of them are completely two different concepts.

Now, let’s see the main difference between the Medical Billing Process and Revenue cycle management.


How are Medical Billing Services and Revenue Cycle Management Distinct from each other?


Let us now check the major differences between these two services so that we can understand this process better.

  1. Medical billing and coding is a small part of revenue cycle management. On the other hand, revenue cycle management is the process that takes place with the help of physician billing and coding.
  1. In medical billing we just have to collect the patient’s medical history and give it to the medical staff. On the other hand, In revenue cycle management there are a number of other administrative tasks as well. This works might be one or all of the following
  • Keep the record of the claims with the insurance companies
  • Analyze the data
  • Payer contracting
  • Provider enrollment
  • Work on Compliance


Why Hire a Certified Coding Specialist or RCM Cycle Specialist


The Revenue Cycle management system is a very vast system. It incorporates all the regulatory and administrative work. In a similar fashion, it also takes into consideration those clinical capacities of a practice or hospital that are related to service revenue. This is the role of the Revenue cycle as per the Healthcare Financial Management Association (HFMA).


Without an RCM Process Expert, the doctor’s office burdens itself with a lot of paperwork. This work is comparatively less related to their professional work. Moreover, the staff cannot focus on appointments and bring more footfalls at the practice. In fact, most of the staff’s time is spent on these extra activities. This extra work could be clerical work, discussing with medical insurance companies about the benefits, sending claims to insurance companies, following up on claims, maintaining the patient’s records, their financial bills, etc. Medical billing and Revenue cycle management are tools in the hands of physicians to ease these responsibilities. This intern helps them focus on the main part which is to take care of their patients.


Legion Healthcare Solutions (LHS) has specialists in the field of medical billing and RCM. They have the best team of experts that tailor-make plans for your organization. They are also able to execute a vigorous medical billing or RCM arrangement. Moreover, they make sure to comply with all HIPAA guidelines. Call today to open the doors of a top-notch RCM and Medical Billing Service for your medical or dental practice.


I hope the blog clears the air of doubt about the two processes. What point would you like to add? Please share your feedback and responses in the comments section below.