The Importance of Revenue Cycle Management in Healthcare - Issaquah Press .

Process Coding



The healthcare industry’s transition from reimbursement to value-based reimbursement impacts traditional RCM (Revenue Cycle Management) in a number of ways. Any healthcare organization or individual experienced practitioner must be financially balanced or strong to provide their uninterrupted services. This is a time when the best healthcare RCM service comes into play.

Healthcare revenue cycle management is the financial process that facilitates control of complex administrative processes and clinical functions such as patient eligibility, claims processing, reimbursement, denied claim management, and revenue generation.

RCM is the backbone of healthcare organizations, helping them pay their bills, manage their resources, and more. According to the International Standard Report, more than 25% of medical billing applications have been rejected and up to 40% of these applications are never resubmitted, meaning healthcare organizations are suffering huge revenue losses.

On the bright side, with a proper RCM process, the healthcare sector can reap the greatest benefits with minimal bad debt write-offs. To understand the precise phenomenon of healthcare revenue cycle management, you must first understand its fundamentals in the medical billing process.

Basics of Healthcare RCM:

  • It starts with a patient’s appointment to seek medical help and ends when the healthcare organizations collect their payments.

  • Initially, the healthcare group administrative staff manages a number of processes such as scheduling appointments, verifying eligibility for insurance, and creating the patient account.

“From a revenue cycle management perspective, impeccable submission of patient information at the time of patient planning and enrollment improves healthcare facility cash flow.”

  • After the patient has been treated, the application process begins. An advanced coder submits the claims with the correct ICD-10 codes, the codes define the value of the reimbursement, and an approved code prevents claims from being rejected.

  • Then comes the important part of private or government payers for the payment. They assess the damage values, check the details ie insurance coverage, contracts etc. and request reimbursement.

  • Most claims are denied due to improper coding, incomplete patient accounts, errors in the patient chart, etc.

  • Then comes the last result of revenue cycle management, namely the maximum compensation. RCM helps healthcare organizations receive reimbursement of maximum claims on time and with fewer rejections.

  • After that, the health groups or the individual veterans do the AR follow-up in which they create health claims, i.e. manually or automatically, and send them to different insurance companies.

  • In the final phase i.e. payment posting, medical billing management software records each patient’s payment with accurate information including patient name, account number, denial information, benefit dates, etc. for future reference.

Importance in healthcare:

It can help healthcare organizations track the exact performance of their financial growth. You can easily determine the approval and rejection rates for claims via an appropriate RCM process. With a flawless RCM process, the healthcare organizations effectively managed their medical billing process and quickly resolved their claims rejection issues.

Here are some of the key benefits of an effective RCM: