Revenue cycle management, also referred to as RCM, is a process that involves the collection of revenue from patients and organizations who are billed for healthcare services. This process typically includes billing and coding, insurance verification, verification of benefits eligibility, and other aspects related to the management of healthcare resources. Some key components of RCM include the following:
– Billing – the process of submitting claims for payment to an insurer or third party payer
– Coding – the use of a standardized system to track and classify patient data, including diagnosis, procedures performed, medications ordered and administered, etc.
– Claims adjudication – the evaluation of a claim to determine if it is valid and eligible for payment
– Collections – the process of communicating with patients or their representatives to collect unpaid amounts owed for care received. This may involve sending multiple bills, contacting delinquent accounts by phone or email, referring outstanding balances for debt collection, etc.
RCM is an important part of every healthcare organization’s revenue cycle. Striving to improve efficiency and performance in this area can help healthcare organizations maximize their revenues by collecting all owed payments from patients and insurers as quickly as possible. This can help ensure that the organization’s financial resources are available to pay for the delivery of services and other operational costs, such as staff salaries and benefits, facility rent or mortgage, utilities, and more.
RCM software and services can be used to help healthcare organizations streamline the revenue cycle management process. These tools may include billing and coding software, automated claims adjudication systems, patient self-pay portals, etc. Some RCM solutions also provide reporting or analytics features that allow users to easily review performance metrics in key areas such as claim denial rates, days outstanding accounts receivable, etc. By using these tools effectively, healthcare organizations can ensure that they are maximizing revenues from RCM activities and providing the best possible care to their patients.