12 Steps of Revenue Cycle Management
Revenue cycle management (RCM) is a vital component of any healthcare organization. It ensures timely and accurate payment for services rendered, impacting everything from patient satisfaction to a practice’s cash flow and financial health. TruBridge’s Revenue Cycle Management solutions help streamline and optimize these processes, making it easier to manage claims and improve financial outcomes.
Revenue cycle management (RCM) is a vital component of any healthcare organization. It ensures timely and accurate payment for services rendered, impacting everything from patient satisfaction to a practice’s cash flow and financial health. But the complete RCM process is much more extensive and cumbersome than many providers realize — and it’s rife with opportunities for error.
Let’s explore all 12 integral steps of the RCM process to understand the importance of having a bulletproof process for each step, no matter the complexity of the claim involved:
12 Steps in the Healthcare Revenue Cycle Process
Revenue cycle management (RCM) involves key steps to ensure timely and accurate healthcare reimbursements. Each phase of the process, from patient scheduling to claims denial management, is crucial for financial health.
Below are the 12 steps of true revenue cycle management, from start to finish:
- Patient scheduling: This first step includes scheduling the patient’s appointment, which helps them receive appropriate care in a timely manner. A well-organized scheduling system integrates with billing and invoicing solutions for a seamless process from start to finish.
- Benefit and eligibility verification: Verifying insurance coverage and patient eligibility to determine coverage levels and out-of-pocket costs. Our Revenue Cycle Outsourcing services can optimize these initial steps, reducing errors and delays.
- Preauthorization: Obtaining preauthorization for certain services can minimize claim denials and maximize reimbursement.
- Patient visit: During the patient’s visit, healthcare providers document the care administered, which is then used to support billing claims.
- Medical transcription: This step involves converting the services rendered into written, billable documentation, allowing for medical coding (classification).
- Medical coding: Assigning the right codes ensures accurate claims and maximizes reimbursement. Our medical coding services provide accuracy and efficiency in translating healthcare procedures into billable codes.
- Charge capture/claims generation and submission: Charges for services rendered are captured and submitted to the appropriate payers to become an outstanding bill.
- Payment posting: Posting payments includes applying payments to the appropriate accounts for accurate financial recordkeeping.
- Secondary billing: Some situations require a secondary payer to cover a portion of the cost. Identifying the secondary payer upfront is often a function of preauthorization.
- Patient billing: Generating patient invoices for remaining balances after insurance payments.
- Accounts receivable: This step involves receiving revenue and reconciling it with claims. TruBridge AR recovery and workdown services can expedite this process, ensuring faster revenue realization.
- Denial management: Addressing and resubmitting denied claims to ensure fair compensation for services provided. TruBridge’s HFMA peer-reviewed services offer proven strategies for resolving denials and maximizing reimbursements.
Optimize Your Revenue Cycle for Greater Success
The healthcare revenue cycle is a complex process, but every step is an opportunity for improvement. By optimizing each phase, healthcare providers can reduce billing errors, minimize denials, and improve cash flow. This leads to increased revenue, better financial health, and enhanced patient satisfaction.
Ready to streamline your revenue cycle? See how our solutions can transform your practice’s financial operations.