Revenue Cycle Management vs
Third Party Administrator
RCM is
a process or software to perform end to end providers activities (Patient
registration, claims processing etc), where as TPA is a person or organization
who works on behalf of payers, providers or members.
TPA
can perform all steps in RCM cycle if they work for a provider.
RCM (Revenue
Cycle Management):
It
is a financial process/medical billing software that healthcare facilities
(providers/hospitals) use to track patient care episodes from registration
and appointment scheduling to the final payment of a
balance.
Purpose
of RCM Systems:
Healthcare
providers use revenue cycle management systems to store and manage patients'
billing records to interact with Payer Systems to receive the payment and other
health IT systems -- such as electronic health record (EHR) and medical billing
systems -- as patients move through the care process.
TPA
(Third Party Administrator):
A
Third Party Administrator (TPA) is a person or an organization that works on
behalf of other healthcare parties like Provider, Payer or Member etc.
Types
of TPA’s:
1.
Works
on behalf of self-insured employers
2.
Works
on behalf of Providers and members
o Performs all RCM functional
operations
3.
Tasks
traditionally handled by insurance companies
o Policy maintenance
o Membership functions
o Premium Billing
o Claims processing
o Provider networks
o Utilization reviews
4.
Other
areas
o Actuarial (Analyzing potential
risks, profits and trends)
o Loss control (Part of Risk
Management)
o Provider service
o COBRA
o Mental health administrations
o Plan Administration
Various
TPA Pricing Models:
1.
Per
Claim basis, Percent of Incurred, and Percent of Paid
2.
%
of revenue
3.
Per
employee per month (PEPM)
4.
Per
member per month (PMPM)
Thanks for sharing about the healthcare revenue cycle management and Third Party Administrator. This article helpful for me.
ReplyDeleteYour blog consistently delivers high-quality content, well done
ReplyDeleteMental health billing services
Very informative!
ReplyDeleteOutsource Medical Billing Services Arizona
Clear and concise comparison! This post does a great job clarifying the roles of RCM systems and TPAs. Understanding how TPAs can fully manage RCM functions when working for providers is especially insightful for healthcare admins.
ReplyDeleteMedical Billing Services
Medical Billing Companies
Revenue Cycle Management Services
medical billing consulting services
Outsourced Medical Billing Services
Medical Billing Outsourcing
Practice Management Consulting
Practice Management Consulting Services s
Great explanation of RCM vs TPA! Tools like Revenue Cycle Management in Arizona from CodeMed-AI can help providers streamline financial workflows effectively.
ReplyDelete