Revenue Cycle Management Explained

Revenue Cycle Management (RCM) is a process that allows a healthcare provider to manage payment, claims processing, and revenue generation. In simplified terms, RCM helps a healthcare provider ensure that he or the facility gets paid timely for services rendered. It entails using technology to manage claims processes at every phase so that the provider doing the billing can monitor the process and address any issues, allowing for the continuous generation of revenue.

The term revenue cycle is highly associated with healthcare. Although many non-health companies follow the same processes of a revenue cycle, they usually call this process by some other names, such as sales or production cycle. In healthcare, the revenue cycle encompasses the entire patient engagement and payment process—from the time a patient calls your office for appointment to the time the balance on his or her account becomes zero.

Effective RCM requires solid data gathering, storage, and dissemination. This means patient data needs to be collected accurately, the bill sent to the insurance company ASAP, and everything else in between is accomplished. Efficiency and time management play huge roles in RCM, and a healthcare provider’s choice of hospital assistance provider will be the main factor that would help him (or the facility) reach targeted revenue goals.