Revenue Cycle Management

As well as you know, hospital, clinics, and larger healthcare systems are known to saves lives and treat patients with care. However, to ensure that it is done properly, every healthcare organization needs to create successful processes and policies in order to stay financially healthy and to keep doing what they do best.

Hence, comes revenue cycle management software into the picture. In the arena of healthcare, RCM works as the financial process facilitating the management of clinical and administrative functions associated with claims processing, payment and revenue generation. The process covers identifying, managing and collecting patient service revenue. With this key financial process, it is impossible for a healthcare organization to keep their doors open to treat patients. All in all, Healthcare revenue cycle management is the strategy used by the healthcare organization to save their medical organization time and money. RCM makes it possible to streamline business side of your medical practice, getting more money per patient, quickly, with lesser wasted efforts.

In the coming sections we will be exploring the basics of healthcare revenue cycle management and how does it impact the healthcare industry.

Well, as per the Healthcare Financial Management Association (HFMA), a revenue cycle consists of the entire clinical and administrative functionalities that are contributing to the capture, management, and collection of patient service revenue.

Here we discuss what all goes into the revenue cycle:

• Pre-registration: Here it fetches the pre-registration details, like insurance coverage, prior to a patient arrives for in-patient or out-patient processing.
• Registration: All the required patient information is fetched as s/he is being registered. It helps in establishing a medical record number as well as meet various regulatory, clinical and financial requirements.
• Utilization Review: The necessity of medical services is examined.
• Coding: Proper coding of diagnoses & procedures is done here.
• Payment collection: Here they determine patient balance and collect payment accordingly.
• Claim submission: Claims are submitted to insurance firms of billable fees.
• Charge capture: Renders medical services into billable charges.
• Remittance processing: The payment is applied and rejected through remittance processing.
• Third-party follow up: Payments are collected from third-party insurers.