Revenue cycle management (RCM) can be defined as the process of handling claims, processing payment and generating revenue in the healthcare industry. It begins just at the time when a patient makes an appointment and continues until the balance on his account becomes zero. It includes various steps like checking patient insurance eligibility and coding claims.

  • RCM is responsible for all administrative tasks including informing patients of an upcoming appointment, reminding payers and patients of an existing balance and questioning insurers, when a claim is denied.
  • It save providers money by reducing the amount of denied claims and enabling patients to pay their bills online.
  • It allows healthcare staff to enter all the information required for claims processing, and avoids the revision or resubmission of claims.
  • The organization can also check where its revenue cycle has the scope of improvement by arranging billing data and producing corresponding reports. 
  • With the help of RCM, an organization can buy analytics software and use dashboards to determine or analyze revenue goals.

Benefits of Revenue Cycle Management (RCM)

    • A well-designed RCM system tracks patient care simplifies the billing and collection cycles, by registering, appointing, scheduling and processing the payment.
    • With the help of RCM, communicating with the EHR and accounting systems becomes easier.
    • Revenue cycle management links administrative data like a patient’s name, insurance provider and other personal information along with the treatment received by a patient.
    • It bridges the gap between the business and clinical sides of healthcare.
    • Healthcare providers take help of revenue cycle management systems for preserving and managing patients’ billing records.
    • It reduces the time between offering a service and receiving payment for it by interacting with other health IT systems like electronic health record systems and billing systems.
    • It enables the RCM system to perform duties automatically. As this was previously handled by employees, RCM has been able to save healthcare practices time.

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