Revenue cycle management (RCM) encompasses the full cycle of medical billing, from eligibility verification, authorizations, claim submission, payment posting, to patient collections. The purpose of RCM is to unify all phases of the medical billing cycle including the clinical and non-clinical responsibilities.
What Is Revenue Cycle Management (RCM)?
The primary goal of revenue cycle management (RCM) is to treat rendering patient services and payment collections holistically. The cycle includes:
- Insurance verification & eligibility
- Patient visits
- Diagnosis coding with ICD10
- Patient procedure coding with CPT & HCPCS
- Claim scrubbing and creation
- Clearinghouse submission
- Claim status
- Payment posting
- AR follow-up
- Patient collections
- Bad debt
- Revenue recognition
Following the delivery of services, the visit is assigned diagnosis and procedure codes for claim submission. The practice submits the claim to the clearinghouse which ultimately sends them to the insurance payer. Any difference between what the insurance policy covers and what the service provider charges either gets adjusted off or billed to the patient. Using the practice management system, healthcare groups can track the status of patient payments.
Benefits of Revenue Cycle Management
Failing to implement proper revenue cycle management procedures will only set up a practice for financial failure. Without a solid RCM process in place, practices will find that they do not receive timely payments from the insurance companies because they do not bill them appropriately. Likewise, this delays when bills are sent to patients and, in turn, how soon patients pay for the services they received.
Additionally, without a revenue cycle management solution in place, crucial activities—including eligibility, claim scrubbing, and payment posting — can begin to fall through the cracks. As a result, the quality of patient care becomes compromised. For all of these reasons, finding a suitable RCM process is essential to operate an effective, profitable practice.
How TempDev Can Help You With RCM
TempDev’s team of experienced consultants, developers, and trainers are here to support enhanced accessibility, as well as customized features and templates. This enables you and your patients to have more control over data with improved transparency. By utilizing APIs between your disparate systems, you can improve both the physician and patient experience.
As part of our streamlining process, we help you implement the Patient Portal, API, and other tools to better support safety, patient engagement, and security. From dashboards to automation and workflow redesign, TempDev offers the comprehensive resources and tools you need to ensure an optimized revenue cycle.
Contact us here or by calling us at 888.TEMP.DEV to begin discussing improving your revenue cycle management.