Revenue Cycle Management
Revenue cycle management (RCM) is the entirety of the financial process for the healthcare system. RCM utilizes the medical billing software that their healthcare facilities use to track patient care from registration through final payments of the balance. This fully encompassing healthcare billing process allows health care facilities to track their revenue cycles and communicate with health insurance companies.
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Components of the Revenue Cycle Process​
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The revenue cycle encompasses both administrative and clinical functions within its umbrella. Here is what the revenue cycle entails:
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Pre-registration: a key component of optimizing the overall process, employees create a patient account that details medical histories and insurance coverages.
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Charge capture: Rendering medical services into billable charges
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Claim submission: Submitting claims of billable fees to insurance companies
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Coding: Properly coding diagnoses and procedures.
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Patient collections: Determine patient balances and collect payments
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Pre-registration: Collecting insurance coverage information before a patient arrives for inpatient or outpatient procedures.
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Registration: Collecting subsequent patient information during registration to establish a medical record number and meet various regulatory, financial, and clinical requirements.
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Remittance processing: Applying or rejecting payments through remittance processing.
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Third-party follow-up: Collecting payments from third-party insurers.
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Utilization review: Examining the necessity of medical services.
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These revenue cycle management systems are then stored into a patients’ billing records saving time and effort for the healthcare facility and expediting the payment process.
Prioritizing patient access and front-end optimization are critical components of the overall success of the process. Oftentimes, claims will go back and forth between payers and providers for an extended period of time.
These processes allow facilities to stay on top of these processes until both parties are satisfied with the resolution. put it simply, healthcare organizations must stay profitable to see the benefits of revenue cycle management.