Revenue Cycle Management Process in Medical Billing – 5 Steps

revenue cycle management drawn with chalk on a chalkboard

Anyone who knows anything about medical billing knows there are serious issues when you’re trying to integrate a Revenue Cycle Management (RCM) process in medical billing. An essential understanding of key indicators of best practices is a must!

New pressure to reduce costs – coupled with the manual processes of coding and billing – is a significant challenge for clinicians and practice decision makers. Fortunately, there’s hope on the horizon. In an earlier post, we covered the revenue process, which is a multi-step system that ensures you get paid for services provided.


What is Revenue Cycle Management?

RCM is a process that works at the foundation of your practice or organization. As a provider, you and your patients are a direct part of the care delivery process, with payers being a significant player in the movement of RCM. When there are outstanding Accounts Receivables (AR), it means that AR is directly affecting the income of you and your fellow providers. If a revenue cycle isn’t appropriately managed, it can cause significant backlogs in payments. Because RCM is a process and not a product, it’s important to give it the proper care and attention it deserves. In this way, your practice is better equipped to become successful and remain that way.

Your claims management may be more efficient when you outsource to an RCM company. This way you know you have a dedicated team of IT personnel to file claims, work on appeals and denials, and follow up on slow payment. Outsourcing or using AI can also aid in insurance eligibility and verification, leaving your qualified staff members available for other tasks.

RCM is a multi-step process. When utilized correctly, it can save you time and money and ensure you’re paid more quickly. The revenue cycle management process is one of the cornerstones to practice success.


5 Steps to an Effective Revenue Cycle Management Process

  1. Patient pre-authorization:  A crucial step that’s often overlooked, pre-authorization is a must for a smooth-running RCM process. When you pre-authorize your patient and the services you intend to provide, you have a clearer expectation of what the insurance company will cover, allowing you to better prepare your patient for their financial obligation.
  2. Charges and coding:   Human error in coding is a significant challenge for all practices. Current Procedural Terminology (CPT) guidelines and the latest International Classification of Diseases (ICD) coding system are complex and can be difficult to use. You can assuage this challenge and ensure you’re billing for the right procedure with a well-honed approach to RCM in medical billing.  A Medical Billing Audit can Increase Profitability and assure efficient and correct coding is applied.
  3. Copayments and deductibles:   Since you already have a pre-authorization, collecting a copayment at time of service is easier. Even better, your patient is likely to understand better the need to pay their deductible and how much their estimated costs will be.
  4. File claims:  This is the most crucial part of the entire RCM process in medical billing. Reimbursement is directly dependent on the correct filing of claims. Human error in code entry can delay or in some cases, stop payment.
  5. Reimbursement:  Incorrect claims filed with the wrong codes won’t be a challenge when you have a team of dedicated coders who are advocating on your behalf. With your team on your side, reimbursement is the simplest part of the RCM process. This is where the true benefit of a functional RCM process becomes evident.


Help Your Practice Thrive with a Polished RCM Process

Remember that RCM in medical billing is an often overlooked key component in your practice that you might not be utilizing to its full capacity. It’s a process where clinical management systems interact with billing systems. An RCM process flowchart will assist your staff to effectively complete each step in your Revenue Cycle Management Process in Medical Billing.

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