What is Revenue Cycle Management?

What is it?
Revenue cycle management (RCM) is the process which includes the generation of an accurate claim, submission of a claim, payment on a claim, and posting of a claim hence collecting revenue of services being rendered. It entails the use of technology to track the claims being processed through each stage of its life cycle so the healthcare provider doing the billing can follow the process and address any issues, allowing for a continuous stream of revenue generation.

How does it work?
What some may not realize is that the revenue cycle actually starts from the moment the patient calls to schedule an appointment. During the scheduling of an appointment, the front office staff should receive and confirm the patient’s eligibility and benefits. This allows for a smoother check-in process enabling swift registration and accurate collection of fees such as co-payments, co-insurances and deductibles. After the provider visit concludes, the claims management process begins. The charges are accepted from the EHR into the billing system. Location, Provider, and etc. are reviewed for accuracy before acceptance of charges. Once charges have been accepted, all appropriate and complaint elements are reviewed before forwarding the claim to the payor. The payor then returns either a payment or denial for the claim. Payments are posted and denials get managed and submitted for reprocessing.

Why are we telling you all of this?
While most may know what the RCM is, your sites/clinics may need to assess and focus on improving efficiency in some or all of these areas. A lot can go wrong during the revenue cycle and MMHCS is here to provide you with extraordinary expertise through our understanding the programs and services you provide and align the revenue you should be collecting. Learn more about our RCM services today.

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