The Key Steps and Benefits of Revenue Cycle Management (2024)

• Kennedy Kylander

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Revenue cycle management is an invaluable part of successful healthcare organizations. Without an efficient billing department, your practice could lose out on thousands of dollars in payer reimbursem*nts, patient payments, and other streams of revenue that your practice depends on to continue running.

Understanding and executing excellent Revenue Cycle Management is an integral component of the success of your entire organization. The steps of the revenue cycle and the benefits of quality Revenue Cycle Management are listed below.

Revenue Cycle Management:

Revenue Cycle Management encompasses the entire revenue cycle from the time of an appointment all the way through the time the patient’s bill is paid in full. This involves deciding whether or not to outsource RCM services to a qualified vendor, implement unified software so that your practice can run more effectively, and choosing what features are important to you and will help you optimize your bottom line.

Step 1: Pre-Authorization and Eligibility Verification

The first step in revenue cycle management is pre-authorization and registration. This is the point at which you gather the patient’s insurance and financial information. Automated eligibility verification tools used at this time benefit you as the provider by giving insight into how you will be paid for different services and benefits patients by preparing them for their financial responsibility. This step within revenue cycle management can be improved with price transparency and insurance verification tools found in fully integrated practice management and medical billing solutions.

Step 2: Services and Charge Capture

Once services have been rendered to the patient, the second step of revenue cycle management is to transcribe services rendered into billable charges in a process called charge capture. This step of revenue cycle management is crucial to the claims process as it is the moment you assign a medical billing code to the claim. With quality medical billing software, your team can gain access to important coding tools that help you code more accurately, ensuring timely reimbursem*nt. Claims scrubbing technology will help make sure each claim is coded accurately, the first time. This can save hundreds and sometimes thousands of dollars in claim re-work and administrative costs associated with claim rejections.

Step 3: Claim Submission and Denial Management

The next step in revenue cycle management is submitting a claim. Once you have completed the charge capture process, it is then up to you to submit the accurately coded claim to the payer. This step in your revenue cycle management process can be improved using a practice management software and RCM services vendor to track your claims in real-time, stopping them in their tracks before they have a chance to be denied. This makes sure your organization is submitting clean claims as high as 99%, earning the fastest payment possible. By outsourcing your billing to an RCM vendor that utilizes a qualified practice management solution, you can automate this task and give your team peace-of-mind, knowing the claim is on the way to the payer.

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Should a claim be denied for any reason, the combination of your vendor and billing software helps you resubmit it as quickly as possible. This step in your revenue cycle management can also be improved by utilizing important features in a quality medical billing solution to easily identify common errors in your coding so that your team can course correct and prevent future denials from taking place.

Step 4: Payment

Once your claim has been reviewed by the patient’s insurance, the payer reimbursem*nt will be on the way and the out-of-pocket cost is then posted for the patient to pay. With an integrated billing solution, your patients can view and pay their bills right in their patient portal. Your integrated practice management solution can also equip you to remind patients of their bills and prompt them to make payments, leading to more on-time and in-full payments. This step should also include quality collections services from your RCM service vendor, helping you optimize patient payments while getting your patients on track to recover from medical debt.

Step 5: Quality Reporting

While the receiving of the payment is technically the last step in the process of revenue cycle management, your practice also needs quality reporting technology that helps you stay on track and avoid costly mistakes. Quality reporting tools in your medical billing software can help you easily identify common mistakes through your revenue cycle management process that is causing money to slip through the crack. Your software and vendor can help you fix these areas and secure your bottom line. Easily reduce days in A/R by identifying trends and roadblocks in your revenue cycle.

To learn more about an integrated practice management and billing solution that can help your practice optimize its revenue cycle management process, click here.