The RCM process: what are the steps in the revenue cycle? (2023)

The revenue cycle is the process by which a healthcare organization receives and bills for patient care. It is an important part of data management and revenue assessment for effective medical records management that leads to organizational excellence. This guide provides a step-by-step breakdown of the revenue cycle, which includes 7 key steps.

Foi o Revenue Cycle Management?

The revenue cycle is the process by which a healthcare organization tracks services provided and bills patients. It includes 7 main steps, each of which is summarized in this guide.

Revenue cycle management is an essential part of a company's success. It provides a stable financial base that can be used to develop and reinvest in the healthcare system for further innovation.

Importance of Revenue Cycle Management

One of the most important aspects of revenue cycle management is its ability to help organizations make decisions about where they need to improve. By comparing their own revenue cycle to that of their competitors, companies can better understand where they stand in terms of efficiency and effectiveness. This information can help them make strategic decisions about where to invest their time and resources to improve the entire revenue cycle.

It is important to note that the entire process of streamlining patient records management is constantly changing as new technologies and methodologies for revenue cycle management emerge. Successful organizations must ensure that they are continually informed of the latest developments and strategies.

Steps Included in Revenue Cycle Management

Below, we take a closer look at the top 7 steps of revenue cycle management.

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Preregistration allows the physician's office to capture real-time information, insurance information and eligibility requirements, often while the patient is still on the phone. This makes for a smooth registration process when the patient arrives at the office. It also allows the medical practice to charge for services immediately upon delivery.


Registration ensures that patient information is correct. The provider will ensure that the patient's address, phone number, date of birth, guarantor, and insurance information are correct. This ensures that the patient can check in quickly and easily when arriving at the office.

load detection

Billing is the process of recording the services provided to the patient. This information is then used to generate invoices and invoices for the services provided. It is important to note that this process should be completed as soon as possible after services are provided to ensure timely billing and collection.

This measure is important as it ensures that hospitals receive full compensation from their payers. In recent years, the rise of healthcare fraud has led to greater awareness of this issue among healthcare professionals. If services are not properly registered for billing, it means they are not properly covered by the payer. been treated in


When a patient requests medical therapy, their health insurance company reviews the claim as medically necessary. If therapy is not deemed necessary, treatment costs may not be covered by health insurance.

Eligibility verification is a process by which a health insurance company reviews a patient's application for medical services to determine whether they are covered by the plan. This process helps ensure that patients receive the necessary medical services.

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filing of claims

Filing health insurance claims is one of the crucial steps in medical billing. This is the process by which health care providers bill health insurers for services provided to patients. If invoices are not sent correctly, this can lead to payment delays and further problems for both the provider and the insurer.

It is therefore important to ensure that all invoice information is correct and complete. This includes the patient's name, address, date of birth and insurance details. It is also important to ensure that all services provided are listed on the invoice. This ensures that there are no late payments.

The hospital submits claims to insurance companies so that payment can be transferred as per contract details. The hospital will work with the insurance company to ensure that all necessary information is included in the claim. This ensures that there are no late payments.

medical coding

Coding is used to translate written descriptions of services, processes, and items into alphanumeric or numeric codes. Medical billers use codes to create bills and insurance claims. This information is sent to the insurer for them to process the payment. By using accurate codes, medical billers can ensure that the insurance company has all the information it needs to pay the bill.


With integrated billing solutions, patients can view and pay their bills directly from the patient portal. This makes it easy for them to keep track of their payments and ensure they don't miss any deadlines.

Payments are the final step in the medical billing process. By collecting payments from patients prior to the delivery of services, healthcare providers can ensure that their clinics have the necessary funds to run smoothly and provide quality care.


Reasons for revenue cycle management

Revenue Cycle Management is a comprehensive suite of solutions that help healthcare organizations manage their revenue and cash flow. By adopting this system, healthcare professionals can ensure that they are paid for the services they provide.

In general, Revenue Cycle Management is a better solution than traditional methods of billing and collecting payments from patients. It provides a more efficient way to manage revenue and cash flow, which helps to improve the organization's financial stability.

Below are some of the top reasons why healthcare providers around the world use Revenue Cycle Management solutions:

improved experience

By adopting a revenue cycle management system, healthcare providers can improve the overall experience for themselves and their patients. This streamlined system eliminates unnecessary processes and simplifies billing and billing complexities. This makes it easy for everyone involved in the process to get what they need, efficiently and without fuss.

Fewer rejections

One of the benefits of Revenue Cycle Optimization is that it reduces the number of rejected claims. When the system runs smoothly, human error is eliminated. This means that the insurer rejects fewer bills, which helps improve the facility's cash flow.

simplified process

The Revenue Cycle Management System helps improve the scheduling process by providing a more efficient way to book appointments. It also helps to improve coding by providing accurate codes for services provided. The billing process is streamlined, making it easier for the hospital to receive payments. And finally, payment processing is faster and more efficient.

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Eliminating complex workflows is essential to improving operational efficiency and ensuring you meet your revenue targets. The fewer processes involved in the billing and billing process, the less chance of human error. This streamlined system will make it easier for everyone involved in the process to get what they need.

revenue maximization

The Revenue Cycle Management System helps improve the billing process by providing a more efficient way to make payments. It also simplifies coding and ensures that claims are not rejected due to human error. Billing is streamlined, making it easier for hospitals or clinics to collect payments from patients before services are provided. Finally, payment processing is faster, making it easier for businesses to meet their financial goals.

Handle related tasks along with backlogs such as B. Payment refusals and follow up, and ensure service providers are reimbursed in a timely manner.

Streamlined workflow

Healthcare providers can streamline their workflow by streamlining the scheduling process, ensuring accurate coding of services provided, and improving billing practices to ensure claims are processed quickly.

Workflow is one of the biggest benefits a company can experience by adopting a revenue cycle management system. Healthcare organization employees can focus on more important tasks instead of worrying about billing and billing.

Being proactive is critical to driving efficiency and revenue growth, and that's exactly what a strong RCM solution does. Knowledge of the revenue cycle management system helps reduce the time it takes to pay claims. With a solution tailored specifically for healthcare providers, organizations can achieve their financial goals by making payment management more efficient.

(Video) Revenue Cycle Overview From Patient Access to Claims Management

On-time collection process

The automation and accuracy of the pick cycle helps speed picks. Suppliers generate their invoices in less time and on-time delivery improves the billing process. Using a revenue cycle management system allows vendors to focus on more important tasks instead of wasting time on administrative tasks. The streamlined process helps improve the overall efficiency of the intake cycle.


Your Revenue Cycle Management (RCM) system is the backbone of your hospital or doctor's office. The RCM process consists of 8 steps designed to answer questions such as "How can I improve my cash flow?", "What happens to all our patients?". and "What treatments should be given next?". If you're looking for a trusted, proven solution that will help ease the financial burden on your employees, keep customers happy, and provide an easy-to-understand audit trail for regulators, email us at .


What are the steps in the revenue cycle management process? ›

The seven steps of revenue cycle include preregistration, registration, charge capture, claim submission, remittance processing, insurance follow-up and patient collections.

What is the process of RCM? ›

Revenue cycle management (RCM) is the financial process, utilizing medical billing software, that healthcare facilities use to track patient care episodes from registration and appointment scheduling to the final payment of a balance.

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.

Which of the following is the first step in the revenue cycle management RCM process? ›

Patient Pre-registration

The first step is always crucial as it starts even before a patient get enrolled in the system. Patient's data include Name, medical history, payer details, and payment mode are collected. These information are collected prior to first visit of the Patient to the hospital.

What is RCM life cycle in healthcare? ›

Revenue cycle management (RCM) is the process through which payments flow for most healthcare organizations—from the point a patient makes an appointment up through co-pays, deductibles, and insurance company payments.

What is an RCM in healthcare? ›

Healthcare revenue cycle management is the financial process facilities use to manage the administrative and clinical functions associated with claims processing, payment, and revenue generation.

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 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 10 steps in the medical billing revenue cycle? ›

10 Steps of the Revenue Cycle Management Workflow
  • Patient Registration and Insurance Eligibility. ...
  • Encounter. ...
  • Charge Capture and Medical Coding. ...
  • Claim Scrubbing and Submission. ...
  • Claim Status Inquiry. ...
  • Remittance Advice. ...
  • Denials and Appeals.

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 are the five primary activities in the revenue process? ›

The five key (primary) activities that generate higher profits include inbound logistics, operations, outbound logistics, marketing and sales, and services.


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