The Truth about Revenue Cycle Management
Updated: May 26
Healthcare has been one of the most important businesses in the last couple of years. While healthcare enterprises take care of keeping us healthy and safe from any sickness that may come to us, these types of companies need to keep their finances in check, so they continue to offer their services.
One of the most common strategies used in healthcare is revenue cycle management. This process includes taking care of several payments insurance companies, or patients have to make to maintain the business afloat. In this article, you will learn the basics of revenue cycle management and how to maintain progress through this process without spending more than the budgeted money.
Revenue Cycle Management
According to Search Health IT, revenue cycle management (RCM) is the financial process utilizing medical billing software that healthcare facilities use to track patient episodes from registration and appointment scheduling to the final payment of the balance.
Although this definition seems a little difficult to understand, it envelops all aspects related to revenue cycle management. It starts by registering the patient into the healthcare facilities and asking for information about their insurance. Once the patient provided the necessary insurance information and the healthcare representatives have contacted the insurance company, the finance process begins.
The finance process begins, the healthcare representatives, also known as medical billers, will report all of the procedures the patient will undergo and report them to the insurance company abiding by ICD-10 codes. After the medical biller provides this information, the insurance company is responsible for providing the necessary information regarding what is covered by the patient's insurance.
You can find the complete process on the official webpage of the Healthcare Financial Management Association. If you have any specific questions or other particular concerns, we recommend contacting the office directly, as they will provide the relevant information for any problem that may arise.
Revenue Cycle Management Process
As mentioned in its title, the revenue cycle process is a circle that repeats itself repeatedly with each new patient. Below, you will find the steps a medical biller needs to follow to create the cycle.
1. Charge Capture
Transforms medical services into billable charges.
2. Claim Submission
Submits claims of billable fees to insurance companies.
Codes diagnoses and procedures to be made to the patient.
4. Patient Collections
Determines patient balances and collects payments.
Collects preregistration information, such as insurance coverage, before the patient arrives at the healthcare center.
Collects the rest of the patient's information once they arrive at the healthcare center. It also establishes a medical record number and meets several regulatory, financial, and clinical requirements.
7. Remittance Processing
Applies or rejects payments through the remittance process.
8. Third-Party Follow-up
Collects funds from insurance companies.
9. Utilization Review
Examines the necessity of medical services and procedures.
Here is an infographic from Search Health IT to help you understand the revenue cycle management.
It is essential to mention that this process is made through healthcare software that needs to be acquired prior to opening a healthcare business. There are a lot of companies that offer automatized processes to make the medical biller's job easier. Companies like GE Healthcare, ADP, or McKesson are examples of enterprises that make this type of software.
An effective RCM system can save time and increase cash flow by automatically interacting with other hospital systems as patients move through the cycle.
Virtual Medical Biller
As we mentioned in the first part of this blog post, you will also learn how to maintain your healthcare finances in check for a lower price. The truth is that healthcare systems are not easy to manage. There are a lot of steps in the revenue cycle management that need specific expertise from the employee doing them. Before committing to hiring a medical biller or taking a few online medical billing courses by yourself, you might want to check on virtual medical billers.
Virtual medical billers are healthcare experts who will take care of your company by keeping your finances in order and saving you time and money. Virtual medical billers save money by only working for the number of hours you need them most, and in some cases, they are located in different parts of the world. You can use this to your advantage whenever a patient comes outside business hours due to emergencies or unscheduled visits.
In addition, virtual medical billers can save you time by taking care of the whole revenue cycle management process. You can find some of the most common tasks and virtues a virtual medical biller has below.
Maintaining patient confidentiality
Knowledge in bookkeeping procedures
Active listening and empathy
Communications abilities with insurance companies and payers
CPT and ICD-10 coding
Knowledge of insurance guidelines such as Medicare, Medicaid, and other requirements and systems
Payment posting and reconciliation
Performing daily, weekly, and monthly reports
If you require medical biller services, you would be much better off with a virtual one. Virtual medical billers can help you save time and take care of lots of other tasks, so there's less for you to take care of by yourself. At New Age Cubicle, we want healthcare companies to reach their full potential while saving the most money without disregarding any tasks. Schedule a free consultation today and make your patients feel secure with your services.