Revenue Cycle Management Explained | Typical RCM Functions

In a nutshell, healthcare Revenue Cycle Management (RCM) is the complete overseeing of the medical billing and payment collection cycle from start to finish. It begins with the initial determination of a patient’s eligibility for a claim, followed by the medical coding process and submission, collection of co-pays and every step in between.  A good RCM partner will handle the entire claims management process with little to no mistakes and at a quick turnaround. This allows healthcare providers to optimize their claim reimbursements and significantly improve their bottom line with no disturbances to their day-to-day functions. 

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In order to improve cash flows and quality of patient care, your RCM partner should be efficient, have open lines of communication on the status of your project, and diligently keep up with the ever-changing regulatory requirements our industry faces.  

Healthcare RCM functions at a glance: 

The revenue cycle management process involves many functions, including:

• Patient registration
• Checking patient eligibility for an insurance claim
• Crucial data collection and data entry
• Coding as per revised guidelines like ICD-10 guidelines, automated patient billing and charge posting
• Electronic claim submission ensuring a high rate of first pass clearance
• Clearance of claim denials and effective denial management, decreasing denial rate
• Automated e-payment posting
• Secondary filing and management of accounts receivable, including patient follow-up
• Avoiding Problems with RCM like miscoded claims
• Enhanced provider business viability with significant cost reduction
• Ensuring a zero-accounts receivable balance with completely paperless processing
• Advanced principles applied by credentialed professionals make a big difference to cash flows

When selecting the optimal healthcare RCM partner, make sure they can efficiently manage your entire billing process, are transparent throughout and practice the highest compliancy standards so you can confidently focus on patient care.