What is Revenue Cycle Management?

What is Revenue Cycle Management?

Think of Revenue Cycle Management (RCM) as the financial heartbeat of your practice. It’s the process that ensures you get paid accurately and on time for the services you provide.

Here’s how it works:

1. Pre-Registration – BEFORE the appointment, your team collects patient demographics, insurance and benefits, and medical history.

2. Eligibility Verification – Confirm active coverage and benefits before the service and identify if pre-authorization is needed.

3. Medical Services Provided – You see the patient and document their visit in the system.

4. Coding & Charge Capture – Your services are translated into standardized codes (CPT, ICD-10 and HCPCS) so insurance companies understand what to reimburse. Critical for “clean claim” submission.

5. Claim Submission – The claim (bill) is sent to the insurance provider for payment. Electronic submission ensures faster processing.

6. Insurance Processing & Payment – The insurer reviews, approves or denies the claim, and payments are recorded (daily reconciliation of payments and adjustments).

7. Denial Management & Appeals – If a claim is denied, we investigate, correct any issues, and appeal if necessary. Maintain <5% denial rate is optimal.

8. Patient Billing & Collections – Any remaining balance is billed to the patient, and follow-ups ensure payment is received. Offer multiple payment options (online & payment plans).

Why Does RCM Matter to You?

Optimizing these areas can:

• Reduce the number of days in Accounts Receivable (A/R)
• Improve collection rates.
• Decrease denial rates.
• Improve cash flow.
• Enhance patient satisfaction.

A well-managed RCM system means you get paid fully and efficiently for every service you provide – without the stress of dealing with insurance and billing issues.

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