13 Key Steps in Revenue Cycle Management (2023)

June 8, 2021

13 Key Steps in Revenue Cycle Management (2)

Significant steps in revenue cycle management

Hospitals, clinics, and healthcare facilities use a healthcare receipt loop to keep track of all clinical and administrative information entering the hospital on a daily basis.Revenue Cycle ManagementIt is not complex, but it is a tedious process that requires a lot of knowledge transmitted by various departments of a hospital. This is often why access to accurate data is critical to running a successful business. EITHERRevenue Cycle ManagementThe process revolves around performing all policy making and clinical functions including capturing, selecting, and collecting service-specific information. So it includes everything from patient registration to bill payment collection.

The prescription cycle has several features to help you understand how the system works.

(Video) RCM |Revenue Cycle Management| Denial Management

1. Programming

Planning is an essential part of the revenue cycle that, if optimized, is sure to increase revenue and enable healthcare providers to deliver quality care. Prior approval requirements, cumbersome processes, and long wait times affect patient satisfaction and have a significant impact on referrals.

Keeping patient convenience in mind and being flexible when scheduling appointments plays an important role in reducing no-shows while maintaining healthy revenue streams. Simplified appointment scheduling with automatic reminders for emails and messages engages the patient through online portals and effortlessly maintains the schedule to avoid long waits.

2. Pre-registration of patients

The first step is always crucial as it starts before the patient is admitted into the system. Patient data includes name, medical history, payer details and mode of payment. This information is collected prior to the patient's first visit to the hospital. Pre-registration helps both the patient and the provider. This not only saves the patient time before going to the doctor, but also ensures ease of cost control.

Because payment information is shared with patients, hospitals can expect their patients to pay their bills on time, reducing the likelihood of healthcare provider default. Pre-registration helps expedite the process and increases the totalpatient experience.

3. Patient registration

All patient information collected during the above pre-registration is carried over during the registration process. If an error is found in the form a patient completes, the patient is informed before the error becomes a more serious problem. Errors on a patient's form can cause long delays for hospitals trying to obtain their form.payment of damagesof payers

4. Entry and Cargo Capture

OEntry of costs into the doctor's accountIt is the step where health insurance companies collect information from their various services to patients and then bill the insurance companies. This action is importantintake cycleManagement, as it ensures that hospitals are fully reimbursed by their payers. This is called performance integrity.


5. Usage Management

In this step, health operators verify the request for medical treatment. The purpose of the eligibility verification is to confirm that the health insurance plan covers essential medical services. In addition, it helps the hospital to reduce costs and assess whether the proposed treatment is appropriate.

6. Medical coding

The practice of communicating procedures and diagnoses is another step. Due to the variety of medicines and health services offered in hospitals,medical codingIt is used to translate written descriptions of services, processes, individual requirements, and items into alphanumeric or numeric codes. While these codes may be irrelevant to individuals, they are used to help hospitals plan the process. Medical billers use these codes to create insurance accounts and claims for healthcare providers and patients.

7. Eligibility and performance verification

Verifying benefits and eligibility is another important step in income cycle management that, if done correctly, would provide a higher rate of clean claims. By maintaining a simple and efficient eligibility verification process, we can safely avoid late payments, billing errors, and non-receipt of payments. Periodic verifications of insurance plan coverage and benefits are required.

8. Application

Filing health insurance claims is one of the crucial stepsmedical bills. When registering a claim, the hospital forwards the claims to the insurers for payment to be transferred according to the contract details. If there were errors or other claims in the submission of the order, there would be delays in the processing of payment and the service providers would receive the amount claimed.

9. Management of refusals

This crucial step involves accepting or rejecting payments after receiving claims. EITHERaccounts receivable managementHospital staff will review the payment received from the insurance provider/payer and assess whether the payment was approved or if there is a discrepancy causing the late payment. In the event of an error, the claim may be sent to the clearinghouse where it will be evaluated and resolved so that the claim is returned to the claimant with the correct payment amount.

10. Insurance tracking

the accAmerican Medical Association(AMA) that 1 in 5 claims are processed incorrectly, leaving the healthcare industry with an 80% accuracy rate when processing and paying claims. This determines the importance of monitoring the insurance for the correct receipt of claims. Some of the most likely issues at this stage could be bounces, underpayments, or non-payment. If the hospital is not satisfied with the reimbursements, it can adjust the rates in the next pending negotiations with the authors.

(Video) RCM Cycle In Hindhi (Revenue cycle management) of Medical coding & Medical Billing

11. Billing and patient billing

In the last stage ofHealthcare Revenue Cycle Management, the patient's balances and liabilities are calculated, and a statement is created. Outstanding invoices are carefully tracked. Payment balances of different patients are tracked. With the rise of high-deductible healthcare programs, patient contact is becoming more important as it is directly proportional to hospital revenue.

12. Cash reserve

Posting cash makes it easy to spot problems and fix them right away, allowing us to see payments and provide a picture of financial practices. When done correctly, the box launch ensures that the main scope of development in revenue cycle management is examined, which can help increase sales.

The cash deposit can be made manually or automatically depending on the coverage provided according to the insurance plan and the economic capacity of the patient. Manual posting is tedious and prone to various errors, which increases the risk rate. On the other hand, auto posting is a digital solution that increases the speed of medical billing while providing a continuous stream of revenue.

13. Reports

It's crucial to avoid costly mistakes and stay on track. To do this, the practice must have high-quality reporting technology. When quality reporting tools are part of your medical billing software, the most common prescribing errors are easily identified, keeping the revenue cycle management process running efficiently.

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How many steps are there in RCM? ›

There are 7 basic steps when it comes to RCM services, and you have an option to accomplish this with a third party or by taking care of it in-house with your own software system.

What are the steps in the revenue cycle quizlet? ›

Terms in this set (6)
  • first step. determine marketing/distribution channels to generate sales.
  • receive and accept orders.
  • third step. deliver goods/services to customers.
  • fourth step. billing credit customers and collecting payment.
  • fifth step. collecting from customers.
  • sixth step. provide support after sale.

What are the 10 steps in the revenue cycle quizlet? ›

Terms in this set (10)
  • Preregister Patients. Schedule and Update Appointments. ...
  • Establish Financial Responsibility. Verify patients' eligibility for their health plan. ...
  • Check in Patients. ...
  • Review Coding Compliance. ...
  • Review Billing Compliance. ...
  • Check Out Patients. ...
  • Prepare and Transmit Claims. ...
  • Monitor Payer Adjudication.

What is basic revenue cycle? ›

Four basic business activities are performed in the revenue cycle: sales order entry, shipping, billing, and cash collection.

What is the 12th step of RCM? ›

Step 12: Patient Collections

Following up with the patients regarding their dues with the proper explanation of the insurance coverage is crucial to ensure proper collections. RCM companies appoint dedicated task groups to follow up on the patients to make sure that the revenue cycle stays strong.

What is KPI in RCM? ›

RCM KPIs enable benchmarking of your revenue cycle's performance with industry peers on the responsiveness of your patient access team, quality of your clinical documentation, the effectiveness of your cash flow cycle, and compliance with guidelines.

Can you skip levels in RCM? ›

The short answer. Yes, RCM allows students to skip level exams, but think carefully about your reason for wanting to do this. The fact is, there are no short-cuts for developing proper technique at your instrument and a proper understanding of musical repertoire.

What is the RCM cycle in US healthcare? ›

Revenue cycle management (RCM) in healthcare is the business process that enables organizations to be paid for providing services. There are 17 unique steps in the revenue cycle, which begins with patient scheduling and ends with payment reconciliation.

What is the US healthcare revenue cycle? ›

The Healthcare Revenue Cycle is defined by the Healthcare Financial Management Association as the set of all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue. The healthcare revenue cycle is a complex process with numerous complicating factors.

What is basic RCM in medical billing? ›

Revenue Cycle Management, or RCM, is the function that all practices, groups, and health systems have in place to, at a minimum: Verify patient eligibility and benefits. Validate and submit claims for payment. Collect payment from both payers and patients.

What is step 8 of the revenue cycle? ›

Step 8: Insurance Follow-Up

At this point in the medical revenue cycle, you have actually collected payment from the payor. During this step, you may experience issues from nonpayment for claims, denials for claims, and under-or over-payment of claims.

What is the first step of revenue cycle management? ›

The first step in revenue cycle management is pre-authorization and registration. This is the point at which you gather the patient's insurance and financial information.

What are the first 3 steps of RCM? ›

3 Phases of RCM: Use Best Practices to Improve Performance
  • Revenue Cycle Phase 1: Setting Appointments & Capturing Patient Demos.
  • Revenue Cycle Phase 2: Capturing Charges & Submitting Claims.
  • Revenue Cycle Phase 3: Remittance Posting, Collections & Data Analysis.
  • How does your practice optimize the revenue cycle?

What are the 4 P's of the revenue cycle? ›

The 4Ps of revenue management are: Pricing, Positioning, Pace and Performance.

What are the 5 steps in the revenue recognition process? ›

5-Step Model For New Revenue Recognition Standards
  • Step 1 – Identify the Contract. ...
  • Step 2 – Identify Performance Obligations. ...
  • Step 3 – Determine the Transaction Price. ...
  • Step 4 – Allocate the Transaction Price. ...
  • Step 5 – Recognize Revenue. ...
  • By Melissa Liu and David Hegstrom, Harris CPAs.

What are the 6 stages of revenue cycle? ›

The Six stages of the revenue cycle are provision of service, documentation of service, establishing charges, preparing claim/bill, submitting claim, and receiving payment.

What are the 7 questions of RCM? ›

The seven questions that need to be asked for each asset are:
  • What are the functions and desired performance standards of each asset?
  • How can each asset fail to fulfill its functions?
  • What are the failure modes for each functional failure?
  • What causes each of the failure modes?
  • What are the consequences of each failure?

What are the first 3 steps in the revenue cycle? ›

The revenue cycle process begins when the patient schedules an appointment and ends when all payments from both insurance and patient are collected.
  • Step 1: Patient Scheduling and Registration. ...
  • Step 2: Insurance Eligibility and Benefit Verification. ...
  • Step 3: Collecting Payment.
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