RCM - Revenue Cycle Management

RCM - Revenue Cycle Management


Revenue Cycle Management is a comprehensive term used to signify not just a small portion billing and collection.

Now a day, it encompasses everything from checking eligibility and collecting pays to coding, bill preparation, entries, claim submission, payment receipt posting and managing accounts receivables.

To get it all done correctly, a practice firm must have a very strong TEAM in charge to this. It must be equipped and timely updated with the knowledge of payer and procedures. The system must also be capable of generating the required reports in timely fashion to facilitate it effectively. Many smaller and mid size firms either lack the resources required to deliver it or the upper management do not posses the deep rooted philosophy to take up such challenge. SO, it's not surprising that many practices have outsourced their RCM to billing services.

To effectively handle RSM in-house, practices must pay specific attention to:

  • Eligibility determination
  • Copy collection
  • Coding
  • Bill submission
  • Bill tracking and posting
  • A/R management
  • Reporting and benchmarking