What is Revenue Cycle Management in Healthcare?

RCM or revenue cycle management is a financial process that uses healthcare billing software. Healthcare organizations use it to track episodes of patient care. This starts at the beginning of the appointment process and goes to the final balance payment.

Revenue cycle management unifies clinical and business healthcare elements. It couples administrative information, such as the patient’s insurance provider and name, with his or her treatment.

The healthcare revenue cycle involves all clinical and administrative functions relating to patient service revenue. Managing it includes:

  • Capturing charges
  • Submitting claims
  • Proper coding of procedures and diagnoses
  • Determining the patients’ balances
  • Collecting patient payments
  • Collecting information preregistration including insurance coverage
  • Collecting patient details during the registration process
  • Processing remittances
  • Following up on third-party payers
  • Collecting insurance payments.

Managing the healthcare revenue cycle depends on a number of factors. These include:

  • Provider productivity
  • Service fees
  • Patient volume
  • Patient payments
  • Insurance claims reviews.

Many healthcare providers have a designated healthcare revenue cycle management system. This system stores and manages billing records for patients. It reduces the length of time between treating the patient and receiving his or her payment.

Healthcare receivable management systems save medical organizations time. They automate processes, such as administrative tasks. They also save money in the long run and cut down on the number of claims denied by insurers.

With proper receivable cycle management, healthcare organizations can improve their cash flow. This enables them to stay afloat in today’s difficult financial times. The right receivable cycle management systems are also vital in transitioning to value-based reimbursement.