What is Revenue Cycle Management?

Revenue Cycle Management in healthcare is that the process of managing claims process, payment, and revenue generation. RCM in healthcare helps a practice to extend the revenue by proper claim management.

If the claims are paid partly or if it’s paid after an extended period of your time then resources from the accounts receivable and collection department need to utilized in order to induce the claim settled.

This delay in claim payment and consecutive follow-ups from the accounts receivable and collection department would generally have a negative effect on the revenue cycle.

Key Players in Revenue Cycle Management

Time Management and productivity play key elements in the healthcare RCM.

There are four key players involved in the RCM of healthcare system namely:

  • Patient
  • Healthcare provider.
  • Billing Company.
  • Insurance Payer

It is important that all the four players align their goals and work in tandem so that the Revenue cycle process runs smoothly.

Healthcare Revenue Cycle Process

Generally, a revenue cycle process involves the following ten steps.

  • Patient verification and scheduling.
  • Patient and provider Encounter.
  • Medical Transcription.
  • Charge Entry.
  • Medical Coding.
  • Claim Submission.
  • Payment Posting.
  • Account Receivable.
  • Write off, Refund, & Collections.
  • Closing of accounts.
Main Functions of RCM strategy A complete RCM strategy is comprised of three main functions:
1. Generate revenue
2. Capture revenue

Practice survival and sustainability depend upon the power to get revenue. By reducing gaps and inefficiencies in scheduling to maximize reimbursement, practices are able to do this goal, but it requires a proactive approach to both scheduling and capture of all necessary patient information and copays up front. When this function of revenue cycle is optimized, practices can increase their revenue by minimizing the amount of no shows.

Once a patient is named from the waiting area, the clinical encounter begins and extends through the time a patient leaves the appointment. The activity that happens during this timeframe is foundational to a practice’s ability to capture revenue and must be thoroughly recorded. Accurate and complete documentation of services rendered and proper coding of these services is required to receive payment at the very best level.

3. Collect revenue

In general terms, back-office billing funct

In general terms, back-office billing functions enable a practice to collect revenue and round out the RCM cycle. Included in this category are the steps associated with billing, posting and collection of payments and should be viewed by practices as the last step of the RCM process.

ions enable a practice to collect revenue and round out the RCM cycle. Included in this category are the steps associated with billing, posting and collection of payments and should be viewed by practices as the last step of the RCM process.