Revenue Cycle Management (RCM)

Manage Your Revenue, Increase Your Profits

Stop letting revenue seep through the cracks. It’s time to optimize your RCM and payment processes to improve your services and your bottom line.

Revenue Cycle Management

What is Revenue Cycle Management and Why is it Important?

Revenue Cycle Management is about more than just paying bills. It’s a complex financial system that encompasses every step of care payment.

An optimized RCM system enhances many aspects of provider facilities, from patient satisfaction to profit margins.

What Does a Revenue Cycle Management Process Look Like?

The healthcare revenue cycle begins with a patient appointment and ends with full payment. Receiving proper reimbursement involves several important steps: 


Pre-Registration & Patient Access

Before an appointment, front-desk workers collect and verify the patient’s personal and insurance information. During the appointment, all given services are recorded for the billing department.


Claim Creation

Billing staff evaluates services rendered to create a claim, translating the highly specific tests and procedures performed into ICD-10 codes, which correlate to reimbursement rates.


Claim Submissions

Claims are submitted to a third-party insurance payor for processing and reimbursement.


Claim Processing

Insurance claims may be denied, paid in full, or only partly remitted. Providers often go back-and-forth with payors to appeal claims denials or underpayments.


Final Payment

Once all services are reimbursed, the cycle ends. Sometimes, this comes from the payor in full. Other times, the provider must notify and collect the remaining balance from the patient, who may not have the available funds.

The healthcare revenue cycle begins with a patient appointment and ends with full payment. Receiving proper reimbursement involves several important steps: 

The Key Factors In RCM

The revenue cycle is anything but straightforward. With so many moving parts, the process can suffer from revenue leakages, like coding errors and unverified insurance eligibility, that you might not even notice at first. But with effective RCM, it’s possible to patch these problem areas, simplify the process, and ensure smooth sailing by focusing on these key areas:

  • Service Pricing – Regardless of your reimbursement model, your prices have to support your bottom line.

  • Patient Information – Update patient files with every visit to ensure claim accuracy and payment accountability.

  • Software & Technology – Automated programs for patient account management, claim tracking, and service coding highly boost RCM efficiency and accuracy.

  • Insurance Eligibility & Contracts – Avoid unfounded claims denials by checking insurance eligibility and claim accuracy, and financially clearing patients beforehand. Negotiate better contract terms with third-party payors to improve claim processing.   

  • Medicare & Government Regulations – Update your payment process to conform with current Medicare and federal initiatives, like the Recovery Audit Program and MACRA.

Benefits of a Revenue Cycle Management System

It’s okay to prioritize patients over profits, but you still need consistent reimbursement revenue to provide effective medical care.

Overhaul your revenue cycle management system to reap the operational and financial benefits:

  • Boosted revenue 
  • Claims tracking & leakage visibility
  • Higher patient satisfaction
  • Greater workflow efficiency
  • Improved business value for investors
  • Reduced staff workload
Expand your managed care contracting team with PayrHealth

How PayrHealth Can Help with Revenue Cycle Management

Are you faced with claims denials, contractual variances, and delayed reimbursements? Our team is here to help. As a third-party contract management firm, Helathcents improves RCM by establishing advantageous payor contracts, providing:

  • Data-driven research to establish facility needs
  • Expanded network access
  • Affordable short-term expertise
  • Effective and assertive negotiation skills
  • Integration of client values
  • ROI-friendly contract terms

Commonly Used RCM Terminology

With constantly updated Medicare policies and technology, RCM vocabulary is always changing, too. As a provider, you need a basic understanding of these terms:

  • Charge Capture – Translating medical services into billable charges for insurance claims and reimbursements
  • ICD-10 – International Classification of Diseases, 10th Edition, an updated universal coding list for billing services
  • Fee-Based Reimbursement – Payment model based on quantity of services, regardless of the patient outcome 
  • Value-Based Reimbursement – Payment model based on quality of services and impact on patient health
  • ACO – Accountable Care Organization; a network of healthcare providers who coordinate medical care to improve the overall quality
  • APM – Alternative Payment Model; billing systems that add payment incentives for raising care quality and lowering costs
  • MACRA – Medicare Access & CHIP Reauthorization Act; a policy that introduced the Quality Payment Program (QPP), which encourages payors to operate under value-based reimbursement models
  • MIPS – Merit-Based Incentive Payment Program; a value-based reimbursement initiative to determine payment adjustments based on cost, quality, software integration, and commitment to clinical improvements

Common Questions About Revenue Cycle Management

A combination of objective marketplace analysis and customized strategy. Quality RCM services like PayrHealth account for your unique patient base, payor relationships, and financial goals.

Outsourced RCM services charge a percentage of your monthly revenue, anywhere from 3% to 9%. This amount is often comparable to or lower than hiring full-time employees.

Affordability, specialized expertise, and reduced workload. An outsourced team takes on the burden of developing an optimal payment process, allowing your staff to focus on patient care.

Your Revenue Cycle