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Updated: Apr 11
What is the definition of revenue cycle management?
Revenue cycle management (RCM) is the financial process, utilizing medical billing software, that healthcare facilities use to track patient care episodes from registration and appointment scheduling to the final payment of a balance. Revenue cycle management is an approach to identifying and resolving points of friction in a provider's revenue cycle. With proper revenue cycle management, health care providers can maximize their claim reimbursements and increase their revenue.
Implementing RCM (Revenue Cycle Management) enables healthcare providers to more easily identify where errors are occurring within the revenue cycle. This decreases the likelihood of claim denials due to easily preventable technical issues, like missing information in the patient’s chart or improper coding.
When healthcare providers avoid claim denials and have their claims approved after the first submission, they receive reimbursements quickly and don't have to spend money investigating and appealing denied claims. For the average hospital, this can result in an additional $5 million in revenue. This statistic alone is a good enough reason why hospitals and other healthcare providers should be asking how an organization can improve its revenue cycle management.
The revenue cycle consists of:
Registration – The first step in the revenue cycle is to register patients for an appointment. This can be done via traditional means, such as calling or visiting a physical office location, or through online registration where patients fill out forms online prior to their visit.
Appointment Scheduling – Once a patient has been registered, they are then scheduled for a specific date and time at which they will receive care from their doctor or other healthcare professional.
Procedure – When it comes time for the procedure itself, it must be scheduled appropriately so that both staff members and patients can be present at the same time. This may involve some sort of coordination between departments or multiple appointments being scheduled at once. Oftentimes these procedures have pre-registration requirements and other paperwork that needs to be completed before treatment begins. After treatment is over, it will need follow-up tests and medication prescriptions that need
Claim submission – Claim submission requires submitting information to the insurance carrier after charges have been entered. The revenue cycle team will examine the charges, procedure code and diagnosis code. They will ask whether the diagnosis supports the procedure performed. If two services are provided, those must be separated and coded correctly.
Patient collections – The most challenging part of the revenue cycle process. In order to collect on a patient’s copayment or deductible at the time of service, front desk staff must be trained to collect that amount by policy. To prevent the collections backlog from snowballing, make sure you have a standard policy for collecting copayments and deductibles that sets the financial expectations for the practice. This is why more and more practices are adopting artificial intelligence solutions for the matter. Not only will it be faster and more efficient, it will also be more accurate than its manual counterparts.
What is revenue cycle management in medical billing?
Healthcare revenue cycle management begins when a patient makes an appointment to seek medical services. The process ends when organizations have collected all claims and patient payments. However, the life of a patient’s account is not as straightforward as it seems.
To start, when a patient arranges an appointment, administrative staff must handle the scheduling, insurance eligibility verification, and patient account establishment. Pre-registration is key to optimizing revenue cycle management processes. Employees create a patient account that details medical histories and insurance coverages during this step.
Once patients arrive at the provider’s office, they are checked in by a member of the registration team. They also receive their first interaction with billing staff who review insurance coverage and confirm any deductibles or copayments before treatment. Medical professionals provide treatment following this phase and send claims to payers for reimbursement based on the CPT codes provided by billing professionals.
The final step in healthcare revenue cycle management is collecting payment from patients or insurers after services have been rendered
Why is Revenue Cycle Management Important?
A successful revenue cycle management process is essential to an organization’s fiscal health. Hospitals and health systems need to be acutely aware of how it works, ways to improve it, and how to tackle common challenges in a rapidly evolving environment marked by increasing demands. A robust and successful revenue cycle management (RCM) process is crucial for health care organizations to ensure timely revenue, steady collections, and financial viability. This makes it possible for them to focus on delivering quality care to patients.
As healthcare insurance programs continue to evolve and patients assume greater financial responsibility, the result is a shift in revenue cycle management. This is further propelled by technology that is transforming the revenue cycle by reducing errors in coding and ensuring timely payments, as well as transparent billing discussions.
Hospitals and health systems have embraced telehealth as a viable care option amid the pandemic. The platform has shown promise in reducing the time and staffing constraints of physically seeing a patient, thereby allowing practices to increase their patient loads, representing a new revenue stream.
Companies like Jorie Healthcare Partners focus on the evolution of revenue cycle management by using industry artificial intelligence. Changing the healthcare space by using Jorie Bots for medical billing and revenue cycle management is something that is hard to ignore.
Jorie Healthcare Partners is a company that specializes in artificial intelligence, or AI. Their goal is to use this technology to help their clients improve their billing processes, increase revenue, and decrease costs. They offer services that range from medical billing services to revenue cycle management.
Revenue cycle management (RCM) definition is the financial process that healthcare organizations use to manage and optimize the administrative and clinical functions associated with patient care, from registration and appointment scheduling to final payment of a balance.
The RCM process encompasses a series of steps, including patient registration, insurance verification, charge capture, coding, claims submission, payment processing, denial management, and reporting. The goal of revenue cycle management is to streamline these processes, reduce errors, increase efficiency, and ultimately improve an organization's financial performance.
Jorie Healthcare Partners is The Most Advanced Medical AI Technology Company
Jorie Healthcare Partners are committed to being a trusted partner by offering customized solutions that address each client's unique needs. Our team of healthcare industry experts has more than 30 years of experience helping providers improve their operations through a wide range of services including:
Jorie Healthcare Partners is a leading, independently owned healthcare practice management and consulting firm that exclusively serves hospitals, health systems, academic medical centers and physician practices using an integrated, multi-disciplinary, tailored approach. We help our clients improve their financial, operational and clinical performance across the organization to sustain long-term, measurable results. This system positions providers of all kinds to succeed in today’s challenging and rapidly changing revenue cycle regulations.
Jorie BOTs – Jorie BOTs are available right now, ready to be customized to your specific needs and revolutionize the way you manage your RCM. Call (888) 522-0022 or schedule a Jorie BOT demo today.
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