(Last Updated On: January 23, 2018)

You may be wondering what revenue cycle management is and how it affects your office. If you’re interested in optimizing the revenue cycle for your office, read on.

Revenue Cycle Management Definition

The definition of Revenue Cycle Management (RCM) in healthcare is the process of managing your office’s claims processing, payment and revenue generation. In order to efficiently manage the patient revenue cycle of your office, you’ll need a medical billing software or practice management software that allows you to effectively keep track of the claims process.  The entire healthcare revenue cycle process includes everything from determining patient eligibility, collecting their co-pay, coding claims correctly, tracking claims, collecting payments and following up on denied claims.

Problems with the Health Care Revenue Cycle

If your office is struggling to stay ahead for patient billing, take a look below to see if you’re encountering the problems below.

Medical Billing Frustration

Frustrated with your office’s medical billing? Consider finding a RCM partner today.

–          Staff has not been properly trained or educated. Optimizing your revenue cycle is like a supply chain; if one person in the chain does their job incorrectly, it will affect the outcome of the rest of the chain.  Coding errors, incorrect data entry (insurance information, patient demographics, etc) or simply a failure to understand how their job affects the revenue of the office can result in your staff making costly mistakes.

–          Lack of communication between staff. While the typical office day can be very busy, it’s important that everyone understands their role in the office’s revenue cycle. Therefore, communication between physicians and office managers must remain open and weekly meetings should occur to review the financial reports including accounts receivables, collections and revenue.

–          Poor workflow. Does your staff check patient eligibility and copay amounts before the patient arrives? Do you check for missing charges against your charge slips? How long does it take your staff to follow up on claims? Without an established workflow, your staff can end up missing steps and/or forgetting tasks which ends up in increased errors and more delays to getting paid.

Why Revenue Cycle Management Is Important

Aside from preventing the problems above, did you know that CMS rejects nearly 26% of all claims and up to 40% of those claims are never resubmitted? This can result in lost revenue of up to 10% per physician.   However, with the proper revenue cycle processes and workflows in place, your office can increase payments while decreasing bad debt write-offs.  (In other words, your practice will stay in business!). How? You may need to invest in an office consultant or medical billing company that specializes in Revenue Cycle Management. They can help you address problems in training, communication and workflow.

Finding Revenue Cycle Management Solutions

For some practices, the responsibilities of the revenue cycle can become overwhelming and conflict with other office duties (managing employees, keeping up with government programs like MACRA and MIPS or other administrative tasks). However, that shouldn’t keep your office from becoming financially efficient. If you interested in optimizing your revenue cycle, consider a Revenue Cycle Management company that will partner with you to get the most out of your office’s revenue cycle.  Don’t wait — every day without the correct processes in place can result in decreased revenue for your office. Consider seeking out an RCM Partner today.

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19 Comments

  1. Kelly Davison on November 5, 2014 at 7:08 pm

    I would like to more about Revenue Cycle Management. I am currently studying to become a medical coder and part of our class curriculum is to know the revenue cycle works and how it is effected by the coders.

  2. Octavia Pickering on December 29, 2014 at 6:37 pm

    Do you have a Revenue cycle Solution Processing book?
    What is the cost?

    • Administrator on January 7, 2015 at 7:36 am

      Hi Octavia, can you elaborate on what you are looking for in a Revenue Cycle Solution Processing book? Are you referring to textbook format?

  3. Elliot Barry on June 22, 2015 at 11:26 am

    RCM is a heart or lifeline for physicians practices. RCM is not limited to medical billing, it’s a huge concept which covers the processing of claims, denial management etc, so every practice should know about the importance of RCM and it’s solution…. And you blog is the one who is providing the complete information regarding the RCM.

  4. Gokula on October 27, 2015 at 1:42 pm

    I want to know what would be cost for revenue cycle solution book. and how i can learn and i need qualification to do that course.

  5. EMR on January 27, 2016 at 4:04 pm

    I, too, am working toward my Medical Coding certificate. Does anyone know of a book or any info that would help me to learn more?

  6. Vivian on February 1, 2016 at 9:13 pm

    I just graduated with my BS in Healthcare Management and I want to pursue a MS in Revenue Cycle Management. Can you recommend or know a program that offer a course in this arena?

  7. On The Money…Modernized Infrastructure And Healthcare Revenue Cycle | Brian D. Cooper on April 5, 2016 at 12:16 am

    […] revenue cycle is the process and flow of patient information (financial and health) throughout the medical […]

  8. Gobardhan on May 19, 2016 at 10:22 pm

    May I know the KPIs that show how a healthcare provider is performing in Revenue Cycle Management?

    • Cortnie Sproul on May 26, 2016 at 10:54 am

      There are many and several different ways to analyze a practices data but hopefully the following will give you a starting point!
      • Gaps between actual service dates and the date claims were filed (How much time does it take the staff to process everything?)
      • Cross referencing charges billed against appointment schedule (Making sure they are not missing any charges)
      • Percentage of clean claims
      • Reimbursement turn-around time from each payer
      • Denial trends by payer (What % are due to front desk mistakes? Identify % of each denial type)
      • Monitoring Insurance AR (Industry standards = 0-90 days should be 80% of higher)
      • Monitoring percentage of money collected against charges billed
      • Quality assurance reviews

  9. K on June 10, 2016 at 10:18 pm

    A revenue cycle management company sent me a personal check. No other documentation or description was provided in the envelope. I am wondering what possible reasons could they have to mail me a check. I know I can call and find out but I am wary to call (call me paranoid, but I worry about possible scams or identity theft…especially when it seems too good to be true)

  10. Revenue Cycle Management (RCM): the basics | Gray Voxels on August 30, 2016 at 9:28 pm

    […] denial analysis and the appeal mechanism is inadequate. According to this link, CMS rejects almost a quarter of all claims and 40% of rejections are never resubmitted! Because […]

  11. Kamaal on November 22, 2016 at 8:12 am

    Hi,

    I wanted to know in which database tables payments & collections sub module data being saved.

    We are trying to create reports using HANA so we want know technical names.
    Your help highly appreciated thanks in advance.

    Thanks in advance..
    Kamaal

    • Administrator on December 12, 2016 at 2:25 pm

      Hi Kamaal, are you a current client with STI?

  12. Riddhi Sheth on June 28, 2017 at 9:42 am

    Please could you suggest me that who all can do this course. If i have done medical codig then can i do this course? nd how can it benefit me?

  13. mary on July 27, 2017 at 12:57 pm

    I am doing a short paper on this article and wondering how I wouls apa cite this

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