Revenue Cycle Management (RCM)

Service Overview

Revenue Cycle Management (RCM) is the process used by healthcare providers to track patient care episodes from registration and appointment scheduling to the final payment of a balance. It integrates administrative, financial, and clinical functions to maximize revenue collection while minimizing errors and delays.

Key Steps in the Revenue Cycle Management Process

• Patient Registration: Collect patient information, verify insurance eligibility, and coverage before services are provided.
• Charge Capture: Document services rendered to patients using appropriate medical codes.
• Coding and Documentation: Translate medical services into standard codes (CPT, ICD-10, HCPCS) for billing.
• Claims Submission: Submit claims to insurance companies or payers electronically or manually.
• Payment Posting: Post payments received and identify discrepancies between expected and actual payments.
• Denial Management: Address denied claims promptly and resubmit or appeal as needed.
• Patient Billing and Collections: Generate and send patient statements, follow up on unpaid bills.
• Analytics and Reporting: Monitor KPIs to improve processes, reduce delays, and enhance cash flow.

Benefits of Effective Revenue Cycle Management

• Increased revenue through faster and accurate reimbursements.
• Reduced errors by minimizing coding and billing mistakes.
• Improved compliance with regulations, reducing legal risks.
• Enhanced patient satisfaction with clear billing processes.
• Better cash flow through efficient collection processes.

Technologies Used in Revenue Cycle Management

• Practice Management Software for scheduling, billing, and patient accounts.
• Electronic Health Records (EHR) for clinical and financial data integration.
• Medical Billing Software to automate claims submission and payment tracking.
• Artificial Intelligence (AI) for claim scrubbing and predictive analytics.
• Analytics Tools to monitor financial performance and identify improvement areas.

RCM Key Performance Indicators (KPIs)

• Days in Accounts Receivable (AR): Time it takes to collect payment after services.
• First-Pass Resolution Rate: Percentage of claims paid on first submission.
• Denial Rate: Percentage of claims denied by insurers.
• Net Collection Rate: Revenue collected compared to what is contractually owed.
• Patient Payment Collection: Percentage of patient balances successfully collected.